A pharmacist-managed dosing algorithm for darbepoetin alfa and iron sucrose in hemodialysis patients: A randomized, controlled trial

Francisca Johanna van den Oever*, Carolien F.M. Heetman-Meijer, Erwin Birnie, Erwin C. Vasbinder, Eleonora L. Swart, Yvonne C. Schrama

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The attainment of target hemoglobin levels in hemodialysis patients is low. Several factors play a role, such as hyporesponsiveness to erythropoiesis-stimulating agents (ESA), but also suboptimal prescribing of ESA and iron. The goal of this study was to investigate if a pharmacist-managed dosing algorithm for darbepoetin alfa (DA) and iron sucrose improves the attainment of target hemoglobin levels. In this randomized controlled trial, 200 hemodialysis patients from a Dutch teaching hospital were included. In the intervention group (n = 100), a pharmacist monthly provided dose recommendations for DA and iron sucrose based on dosing algorithms. The control group (n = 100) received usual care. In the intervention group, the percentage per patient within the target range (PTR) for hemoglobin (target range 6.8-7.4 mmol/L) and iron status was higher than in the control group (for hemoglobin median 38.5% vs 23.1%, P =.001 and for iron status median 21.1% vs 8.3%, P =.003). The percentage of high hemoglobin levels (>8.1 mmol/L) was lower in the intervention group (median 0.0% vs 7.7%, P =.034). The weekly dose of DA was lower in the intervention group (median 34.0 vs 46.9 mcg, P =.020), whereas iron dose was higher (median 75 vs 0 mg). No difference was found for the percentage of hemoglobin levels below the target range. In conclusion, a pharmacist-managed dosing algorithm for DA and iron sucrose increased the attainment of target levels for hemoglobin and iron status, reduced the percentage of high hemoglobin levels, and was associated with a lower DA and a higher iron sucrose dose.

Original languageEnglish
Article numbere00628
JournalPharmacology Research and Perspectives
Volume8
Issue number4
DOIs
Publication statusPublished - 1 Aug 2020

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