Case management of the anemic patient. Focus on hemodynamics

Cardiac function of dialysis patients improves when severe anemia is corrected with Epoetin alfa. Direct clinical changes include a decrease in cardiothoracic ratio and diminished left ventricular size. Exercise-induced cardiac ischemia as noted by depression of the S-T segment on EKG is also reduced. Nephrology nurses must monitor hemodynamic changes, provide patient reeducation, and encourage patient compliance with medication regimens.