Implementation of a Nurse-Empowered Renal Anemia Protocol in Children

Area of Science:

• Nephrology
• Pediatric Hematology
• Nursing Science

Background:

• Many pediatric hemodialysis patients struggle to reach target hemoglobin levels despite erythropoiesis-stimulating agent (ESA) therapy.
• Anemia in renal disease is a common complication impacting patient well-being and treatment efficacy.

Purpose of the Study:

• To evaluate the impact of a registered nurse-driven renal anemia protocol on achieving target hemoglobin (Hgb) and transferrin saturation (TSAT) in a pediatric hemodialysis unit.
• To assess changes in Hgb concentration and key clinical outcomes following protocol implementation.

Main Methods:

• A prospective study comparing patient outcomes before and after implementing a nurse-driven renal anemia protocol.
• Data collection focused on the proportion of patients achieving target Hgb and TSAT, alongside medication doses, transfusion rates, and hospitalization frequency.

Main Results:

• A significant increase was observed in the proportion of patients achieving target Hgb and TSAT levels post-protocol implementation.
• Mean Hgb concentration also increased, indicating improved anemia control.
• No significant differences were found in left ventricular hypertrophy, ESA or iron doses, transfusion rates, or hospitalization rates.

Conclusions:

• Implementing a nurse-driven anemia protocol effectively enhances anemia management in pediatric hemodialysis.
• The protocol successfully increased the proportion of patients reaching target Hgb and TSAT without escalating medication or iron administration.
• This approach demonstrates a valuable strategy for optimizing care in pediatric renal anemia.