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Robert M. Perkins, MD

Robert M. Perkins, MD, is Director of Dialysis, Department of Medicine/Nephrology Service, Walter Reed Army Medical Center, Washington, DC.

Stephen Olson, MD

Stephen Olson, MD, is Staff Physician, Department of Medicine/Nephrology Service, Walter Reed Army Medical Service, Washington, DC.

Janice Hansen, RN

Janice Hansen, RN, is Head Nurse, Department of Medicine/Nephrology Service, Madigan Army Medical Center, Tacoma, WA.

Joseph Lee, DO

Joseph Lee, DO, is Staff Nephrologist, Kidney Specialists of Minnesota, Roseville, MN.

Kevin Stiles, MD

Kevin Stiles, MD, is Chief of Nephrology, Kaiser Permanente, Bakersfield, CA.

Christopher Lebrun, MD

Christopher Lebrun, MD, is Vice President, Nephrology Associates PC, Columbus, MS.

Aim. There is limited data regarding the impact on hospital resource use of a dedicated, nurse-managed anemia clinic in patients with pre-end stage chronic kidney disease.
Methods. A retrospective cohort study was conducted comparing patients with pre-end stage anemia of chronic kidney disease enrolled in an algorithmic anemia clinic (N = 27, treatment group) with un-enrolled patients with chronic kidney disease (N = 22, control group). The treatment group received algorithmic treatment with recombinant human erythropoietin and intravenous iron sucrose, while controls received usual care. The primary outcomes investigated were emergency room visits and hospitalizations during a 1-year period.
Results. The two groups were similar at baseline. During the first year of clinic enrollment, the mean hemoglobin values improved in the treatment group from baseline and compared with controls (11.6 ± 1.2 g/dl vs. 10.3 ± 1.0 g/dl, p < 0.05). The relative risk of an emergency room visit (RR 0.18, 95% CI 0.05-0.67, p < 0.05) and hospitalization (RR 0.20, 95% CI 0.06-0.67, p < 0.05) were reduced in the treatment group versus the control group. The average length of hospital stay was also reduced (6.8 days vs. 9.5 days, p = 0.05).
Conclusion. Enrollment in a dedicated nurse-managed anemia clinic is significantly associated with reduced emergency room visits and hospitalizations in patients with pre-end stage CKD. These associative findings justify future prospective analyses to establish causality.