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NEPHROLOGY

Meeting New Challenges in the Management of Anemia of Chronic Kidney Disease Through Collaborative Care with Pharmacists

Clinical Pharmacist, VillageHealth Disease Management, Vernon Hills, IL

Neeta O'Mara, PharmD BCPS

Clinical Pharmacist, Dialysis Clinics, Inc., North Brunswick, NJ

Harold Manley, PharmD BCPS FCCP FASN

Director of Clinical Pharmacy, VillageHealth Disease Management

Steven Fishbane, MD

Chief of Nephrology and Director of End Stage Renal Disease Research, Winthrop-University Hospital, Mineola, NY

Reprints: Dr. Bacchus, VillageHealth Disease Management, 3 Hawthorn Parkway, Vernon Hills, IL, Efax 443/773-1958, Shaffeeulah.Bacchus{at}Villagehealth.com

OBJECTIVE: To evaluate chronic kidney disease (CKD)–associated anemia management challenges and limitations and discuss strategies to improve treatment rates and patient response to therapy, monitoring of patient response to therapy, and education of prescribing providers and patients.

DATA SOURCES: Multiple MEDLINE searches were performed using a comprehensive search term list to identify studies for inclusion, including, but not limited to, anemia, erythropoiesis-stimulating agent (ESA), epoetin, darbepoetin, CERA, hemoglobin, CKD, dialysis, end-stage renal disease, quality of life, and pharmacist. Annual data reports and clinical practice guidelines published by the National Kidney Foundation and US Renal Data System were included. Information provided within product package inserts for recombinant human erythropoietin (epoetin alfa; Epogen, Procrit) and darbepoetin alfa (Aranesp) were also included.

STUDY SELECTION AND DATA EXTRACTION: Only articles that were published in English and were relevant for this review were included.

DATA SYNTHESIS: Anemia is a common complication of CKD, with significant impact on patients' quality of life. Anemia of CKD represents a significant burden on the healthcare system, with ESA use resulting in substantial financial costs. As new therapies, formularies, and dosing regimens evolve, the collaborative role of the clinical pharmacist is integral to a multidisciplinary treatment strategy, both in the inpatient and outpatient settings, such as hospitals or dialysis centers, respectively. This review focuses on initial and target hemoglobin (Hb) concentrations, as well as patient characteristics, treatment preferences, and dosing schedules, which are important considerations in managing CKD-associated anemia. To ensure effective therapeutic strategies, a patient-centered approach is required. Pharmacists are ideally positioned to help select ESA therapy, influence formulary use, educate healthcare professionals and patients, develop and implement dosing and monitoring protocols, and possibly promote quality improvement.

CONCLUSIONS: An approach to CKD-associated anemia management that involves collaboration with pharmacists is essential to achieve patient-specific, cost-effective ESA therapy.

Key Words: anemia, chronic kidney disease, darbepoetin, epoetin

Published Online, October 13, 2009. www.theannals.com, DOI 10.1345/aph.1M035