Israeli Ruth, Gabay Gillie, Shafran Tikva Sigal, Exman Michal, Mor Yosef Levi Irit, Radiano Ruth, Alon Rely, Lerman Yulia, Zelker Revital
Dialysis Unit, "Ziv", Hadassah Ein-Kerem Medical Center, Jerusalem 91120, Israel.
School of Science, Achva Academic College, Shikmim 79804, Israel.
Healthcare (Basel). 2025 Jun 2;13(11):1317. doi: 10.3390/healthcare13111317.
The ongoing clinical challenge of managing hemoglobin levels in chronic dialysis patients is exacerbated by the gap between growing patient needs and the limited availability of nephrologists. Clinical nurse specialists (CNSs) have been contributing to the successes of modern healthcare systems across Europe, but there is a limited understanding of specific mechanisms by which CNSs can support and improve patient outcomes in renal diseases. Responding to previous calls, this intervention study evaluated the role of nephrology CNSs in dialysis patient care. This intervention study employed erythropoiesis-stimulating agents (ESAs) to investigate whether a personalized, tailored protocol led by nephrology CNSs could improve the hemoglobin balance compared to the conventional standard of care led by nephrologists. Thirty-nine patients who met the inclusion criteria with a preset hemoglobin value between 10.5-12 g/dL completed the study. There were no significant differences in hemoglobin levels between patients managed by nephrologists and those overseen by CNSs. Hemoglobin variability remained unchanged after protocol implementation, while key dialysis quality indicators (e.g., iron saturation, urea reduction) remained within safety limits. Notably, ESA-related medical adjustments were significantly reduced, requiring half as many modifications over 12 study points. A CNS-led personalized protocol effectively maintained dialysis patient parameters within established safety thresholds. These findings reinforce the critical role of CNSs in enhancing the efficiency, effectiveness, and safety of hemoglobin management in this high-risk population. Policy implications are discussed.
慢性透析患者血红蛋白水平管理方面持续存在的临床挑战，因患者需求不断增加与肾病专家数量有限之间的差距而加剧。临床护理专家（CNSs）在欧洲现代医疗体系的成功中发挥了作用，但对于CNSs支持和改善肾脏疾病患者预后的具体机制，人们了解有限。回应之前的呼吁，这项干预研究评估了肾病CNSs在透析患者护理中的作用。这项干预研究使用促红细胞生成素（ESAs）来调查，与肾病专家主导的传统标准护理相比，由肾病CNSs主导的个性化定制方案是否能改善血红蛋白平衡。三十九名符合纳入标准、预设血红蛋白值在10.5 - 12 g/dL之间的患者完成了该研究。肾病专家管理的患者与CNSs监管的患者之间，血红蛋白水平没有显著差异。方案实施后，血红蛋白变异性保持不变，而关键透析质量指标（如铁饱和度、尿素清除率）仍在安全范围内。值得注意的是，与ESA相关的医疗调整显著减少，在12个研究点所需的调整次数减少了一半。由CNSs主导的个性化方案有效地将透析患者参数维持在既定的安全阈值内。这些发现强化了CNSs在提高这一高危人群血红蛋白管理的效率、效果和安全性方面的关键作用。文中还讨论了政策影响。
