Computerized Decision Support for EPO Dosing in Hemodialysis Patients

Background: Anemia management in hemodialysis patients poses significant challenges. The present study explored the hypothesis that computerized dosing of intravenous erythropoietin (EPO) would increase the percentage of hemoglobin (Hb) values within the target range and reduce staff time spent on anemia management. Study Design: Retrospective cohort. Setting & Participants: In-center hemodialysis patients who received EPO at Dialysis Clinic Inc dialysis units for at least 3 months between October 1, 2005, and April 30, 2006. Quality Improvement Plan: Computerized decision support (CDS) for EPO dosing is compared with manual physician-directed dosing. Outcomes: Achieved monthly Hb values, quantity of EPO administered, and time spent by dialysis unit personnel. Measurements: Monthly Hb and quantity of EPO administered to 1,118 patients from 18 dialysis units treated using CDS and 7,823 patients from 125 dialysis units treated using manual dosing. Results: There was no difference in the likelihood of a monthly Hb level of 11-12 or 10-12 g/dL using CDS compared with manual dosing. The likelihood of an Hb level > 12 g/dL decreased and the likelihood of an Hb level < 10 g/dL increased using CDS. EPO use was 4% lower using CDS, although the difference was not statistically significant. CDS was associated with a nearly 50% decrease (P < 0.001) in the time spent by dialysis unit staff on anemia management. Limitations: Retrospective and nonrandomized. Conclusion: The number of monthly Hb values in an 11 - (and 10-) to 12-g/dL target range and EPO use did not differ with EPO dosing using CDS compared with manual dosing. Staff resources devoted to anemia management decreased significantly using CDS. Am J Kidney Dis 54:1081-1088. (C) 2009 by the National Kidney Foundation, Inc.