Management of anemia in patients receiving peritoneal dialysis carries more challenges compared with anemia management in patients receiving hemodialysis. Peritoneal dialysis patients are seen infrequently and, due to factors related to finances, social life, and work life, noncompliance with anemia regimens is more common among peritoneal dialysis patients than among hemodialysis patients. The limited time and interaction between patient and clinician contribute to limited success in anemia management in peritoneal dialysis patients.
At Hamad General Hospital, Doha, NA, Qatar, anemia management in peritoneal dialysis was transferred to a multidisciplinary team led by a trained peritoneal dialysis nurse. Abdullah Hamad, MD, and colleagues conducted a retrospective cohort study to examine the impact of the new model to achieve anemia targets. Results of the study were reported online in an abstract from the NKF 2020 Spring Clinical Meetings.
The study included all patients on chronic peritoneal dialysis for more than 1 month in Qatar. The researchers reviewed data from June 2017 to July 2018; the multidisciplinary team model was initiated in August 2017. Patient characteristics, laboratory test results, and medications were identified via electronic medical records and quality data.
The mean census during the study period was 180 (range, 177-184). Throughout the study period, an average of 76% of patients were treated with erythropoietin stimulating agents (ESA) (range, 67% to 82%). Following initiation of the multidisciplinary team model, the number of patients with monthly office visits and measured hemoglobin (Hb) improved from 73% to 83%, and the number of patients requiring a monthly Hb recheck decreased from 30% to 17% (P=.01).
The percentage of patients in the target Hb range of 10 to 12 g/dL improved from 52% in June 2017 to 68% in July 2018 (P=.009). Extreme Hb, defined as <9 or >13 d/dL, also improved, from 13% to 8% during the same time period; there were no changes in ferritin and iron saturation levels.
A third of the patients received financial aid for their ESA regimen. Noncompliance with monthly visits and ESA adherence was reduced from 20.5% to 10% (P=.03) following the multidisciplinary team model initiation. The ESA dose was reduced by 6%, with an estimated cost savings of $30,000 annually.
“Anemia management in peritoneal dialysis was shifted to a multidisciplinary team model. The new model achieved better target Hb and decreased extreme Hb levels. It also improved compliance, efficiency, and cost benefit. A multidisciplinary team model should be considered more in peritoneal dialysis management,” the researchers said.
Source: Hamad A, Ezzat H, Futotana M, et al. Effect of multidisciplinary team on anemia management in peritoneal dialysis patients. Abstract of a presentation at the National Kidney Foundation 2020 Spring Clinical Meetings; abstract #187.