Pharmacotherapy quality and patient safety in haemodialysis patients treated with erythropoiesis-stimulating agents

de Diego Santos, T.; Martí, M. Climente; Albert Balaguer, E.V.; Jiménez Torresa, N.V.

doi:10.1016/S2173-5085(08)70053-4

Farmacia Hospitalaria

ISSN: 1130-6343

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Observational, longitudinal study. Retrospective analysis (period A) and prospective analysis (period B) following implementation of the programme for haemoglobin values and monthly erythropoiesisstimulating agent dosage. The proportion of patients with haemoglobin values within the target range (10-5-12.5g/dL) and those with values above the safety limit (≥12.5g/dL) were compared every 4 months and the average percentage of time with haemoglobin values within the target range and above the safety limit were compared during periods A and B.

Results

Fifty-nine patients were included in the study. The proportion of patients with haemoglobin levels within the target range increased from 28.8% to 65.4% (RR=2.27; 95% CI, 1.56–3.30) and the value in patients with haemoglobin levels above the safe level reduced from 57.6% to 19.2% (RAR=0.39; 95% CI, 0.19–0.55). The time with haemoglobin levels in the target range increased 15.7% (95% CI, 7.1–24.2) and the time with values above the safe level reduced 26.9% (95% CI, −35.1 to −18.6). The number of patients included to avoid one reaching a haemoglobin value above the safe range was 2.6 (95% CI, 2.5–2.7).

Conclusions

The implementation of an improvement programme for the quality of pharmacotherapy with erythropoiesis-stimulating agents in patients with haemodialysis significantly increases the proportion of patients with haemoglobin values within the recommended ranges of effectiveness and safety.

Keywords:

Renal anaemia

Chronic renal disease

Erythropoiesis-stimulating agents

Patient safety

Quality improvement

Resumen

Objetivo

Evaluar un programa interdisciplinario de mejora de la calidad de la farmacoterapia y la seguridad de los pacientes con enfermedad renal crónica tratados con estimulantes eritropoyéticos.

Método

Estudio observacional longitudinal. Análisis retrospectivo (período A) y prospectivo tras implantar el programa (período B) de valores de hemoglobina y dosis de estimulantes eritropoyéticos mensuales. Se compararon, cada 4 meses, la proporción de pacientes con valores de hemoglobina dentro del ámbito objetivo (10,5–12,5g/dl) y superiores al límite de seguridad (≥12,5g/dl), y el porcentaje medio de tiempo con valores de hemoglobina dentro del ámbito objetivo y superiores al límite de seguridad, respectivamente, durante los períodos A y B.

Resultados

Se incluyeron 59 pacientes. La proporción de éstos con hemoglobina dentro del ámbito objetivo se incrementa de un 28,8 a un 65,4% (riesgo relativo=2,27; intervalo de confianza [IC] del 95%, 1,56–3,30) y la de pacientes con hemoglobina superior al límite de seguridad se reduce de un 57,6 a un 19,2% (reducción absoluta del riesgo=0,39; IC del 95%, 0,19–0,55). El tiempo con hemoglobina en el ámbito objetivo se incrementa un 15,7% (IC del 95%, 7,1–24,2) y el tiempo con valores superiores al límite de seguridad se reduce un 26,9% (IC del 95%, −35,1 a −18,6). El número de pacientes que hay que incluir para evitar que uno alcance un valor de hemoglobina superior al límite de seguridad fue 2,6 (IC del 95%, 2,5–2,7).

Conclusión

La implantación de un programa de mejora de la calidad de la farmacoterapia con estimulantes eritropoyéticos en pacientes en hemodiálisis aumenta significativamente la proporción de pacientes con valores de hemoglobina dentro del ámbito de efectividad y seguridad recomendados.

Palabras clave:

Anemia renal

Enfermedad renal crónica

Factores estimulantes eritropoyéticos

Seguridad del paciente

Mejora de calidad

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☆

This study has been partially presented in the 52nd National SEFH Conference. Tenerife 2007

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