The utilisation of a simple algorithm to achieve Renal Association guidelines in Anaemia Management.

C Johnson, RJ Fluck, MW Taal, CW McIntyre

Derby City General Hospital

Problem Anaemia associated with chronic renal failure has a major impact on our patient population, with evidence to suggest that patients with sub-optimal haemoglobin have a higher relative risk for mortality, increased incidence of hospitalisation and reduced quality of life. The treatment options available for anaemia management demands high per patient cost. The challenge remains the provision of a cost-effective utilisation of resources, which maximise the achievement of target haemoglobin set by the Renal Association.

Purpose To determine the efficacy of a simple anaemia management algorithm on the achievement of the target haemoglobin of10g/dl and adequate iron status, defined by a serum ferritin >100ug/l as recommended by the Renal Association (2002).

Design A simple, responsive anaemia management algorithm was designed to provide a framework to achieve a target haemoglobin in line with Renal Registry standards, endorsed within the NSF for Renal Services, aiming for a target haemoglobin of between 11-12.5g/dl .

Initiation provided guidance for commencement of Erythropoetic Stimulating Agents dependent on modality. Recommending monthly monitoring of FBC and quarterly monitoring of haematinics.

Modulation provides a framework for percentage dose adjustment based on haemoglobin and adjustment of maintenance iron schedule based on serum ferritin.

Findings: Haemodialysis population

Conclusion The implementation of a simple, practical framework to guide all staff in anaemia management has had a positive impact on the achievement of recommendations by the Renal Association (2002).

Relevance The positive outcome to this simple algorithm has had a significant impact on practice and may influence other units to adopt a similar approach