Laboratory trend analyses and proactive adjustments to minimize the need for holding epoetin alfa doses.

Holding doses of epoetin alfa (Epogen) alters the balance between red blood cell production and death rates, and leads to a decrease in hemoglobin (Hb) levels. Although clinical circumstances sometimes require that epoetin alfa doses be held, this can be minimized by monitoring longitudinal trends, predicting the probable future course of Hb, and intervening to proactively adjust epoetin alfa doses before holding is required.

Hemoglobin variability: managing the higher end of the target range.

Management of patients at both the lower and the upper ranges of the hemoglobin target range is crucial to ensuring optimal anemia-related outcomes in patients on dialysis. Nurses can be instrumental in helping to minimize the percentage of patients with hemoglobin levels above the target range through ongoing assessments of longitudinal trends, use of an anemia management protocol that integrates all aspects of care, and prompt adjustments in the Epoetin alfa dose when trend analysis reveals a risk of overshooting target levels.

C-reactive protein and anemia: implications for patients on dialysis.

C-reactive protein (CRP) is an acute-phase reactant protein that increases significantly in the presence of intercurrent (concurrent) events such as infectious and inflammatory processes. Data indicate that CRP levels correlate with anemia parameters, higher levels being associated with an increased comorbidity burden, lower hemoglobin (Hb) levels, and higher Epoetin alfa dose requirements. This article explores the use of CRP monitoring in patients on dialysis, and the relationship to anemia outcomes.

Infection and inflammation in patients on dialysis: an underlying contributor to anemia and epoetin alfa hyporesponse.

Acute or chronic infections or inflammatory conditions can exacerbate anemia in patients on dialysis. The primary goal is to identify and treat the underlying disorder, while minimizing the impact on hemoglobin (Hb) levels. Nurses can be instrumental in minimizing the impact of these conditions by monitoring the longitudinal trends in Hb levels, proactively assessing patients for inflammatory or infectious conditions, and intervening to resolve causative conditions and minimize the impact on anemia.

Functional ability of patients on dialysis: the critical role of anemia.

Maintining hemoglobin (Hb) levels in the range (11 to 12 g/dL) recommended by the National Kidney Foundation's Kidney Disease Quality Initiative (NKF/KDOQI) has been shown to significantly improve functional ability in patients on dialysis. The combination of partial anemia correction and an individualized exercise program yields additional incremental benefits. Nurses fulfill a crucial role in ensuring that appropriate Hb levels are maintained while at the same time encouraging patients to improve their physical conditioning and functional status.

Adherence to the dialysis prescription: partnering with patients for improved outcomes.

Nonadherence is common in the U.S. dialysis population.

Hemoglobin variability: impact on anemia management practices.

Data indicate that a wide range of factors can contribute to inter- and intrapatient variability in hemoglobin (Hb) levels in dialysis patients. Some of these factors are controllable and can be minimized by implementing nursing practices that encourage consistent and accurate Hb assessments and management. However, many of these factors are difficult or impossible to modify, and natural intrapatient variations are therefore expected and unavoidable.

Timely correction of anemia at the initiation of dialysis. Case study of the anemic patient.

New patients starting dialysis typically have hemoglobin (Hb) and hematocrit (Hct) levels well below the target range of 11 to 12 g/dL (33% to 36%) recommended by the NKF-K/DOQI. Despite the emphasis on anemia as a quality indicator, low Hb levels often persist for months after dialysis is initiated. Several factors can help promote timely correction of anemia.