Step-Wise Management of Anemia in CKD

Patients with chronic kidney disease (CKD) frequently experience anemia, a common complication associated with increased cardiovascular risk and reduced quality of life. However, according to Gayathri Delanerolle, MBBS, MSc, and colleagues, anemia is often suboptimally managed. Many patients are managed in the setting of primary care along with other comorbidities.

The researchers conducted a qualitative study designed to evaluate the effectiveness of an audit-based education (ABE) intervention in improving the management of anemia in CKD in primary care. Results were reported online in the Journal of Primary Care & Community Health [].

The study examined outcomes that would be relevant to practitioners and patients, those that expose variation of practice from the National Institute for Health and Care Excellence (NICE) guidelines, and whether the intervention was feasible and acceptable.

Practitioners from five primary care groups and seven patients from four practices in London, England, participated in the discussions. The practitioners welcomed the evidence-based step-wise intervention. However, they felt that prescription of erythropoiesis-stimulating agents (ESAs) was outside the scope of their practice.

There was a gap between NICE guidance and clinical practice among the primary care providers. Iron studies were not well understood and anemia was often conservative or delayed.

Patients were often unaware of having CKD, and were more concerned about other comorbidities. They were largely trusting of their primary care provider’s ability to manage them appropriately.

In summary, the researchers said, “The first steps of the intervention were welcomed by practitioners, but they expressed concerns about independently prescribing ESAs. Renal physicians and general practitioners could develop shared care protocols for ESA use in primary care. There is scope to improve awareness of renal anemia, and enhance knowledge of guideline recommendations; and our intervention should be modified accordingly.”