{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:13:38Z","timestamp":1779336818734,"version":"3.51.4"},"reference-count":50,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,21]]},"abstract":"<jats:p>Introduction: Anemia management in dialysis is challenging. Keeping hemoglobin levels within a tight range is difficult. A new program (anemia nurse manager [ANM]) was started for better anemia management. This study aimed to compare traditional anemia management with the new ANM model regarding the achievement of better hemoglobin targets (range, 10\u201312 g\/dL), avoidance of extreme hemoglobin levels (\u00a0&lt;\u00a09 or &gt;13 g\/dL), and evaluation of the cost-effectiveness of the new model.<\/jats:p>\n                  <jats:p>Methods: This retrospective observational study compared traditional anemia management with management involving our new ANM model. Patients on hemodialysis in all ambulatory dialysis clinics in Qatar were included. The study included three phases: phase 1 (observation): June 2015 to August 2015, 460 patients; phase 2 (pilot): September 2015 to May 2016, 211 patients; and phase 3 (expansion in two phases): June 2016 to February 2017 and October 2017 to June 2018, 610 patients. Hemoglobin, iron saturation, and ferritin were evaluated according to the protocol.<\/jats:p>\n                  <jats:p>\n                    Results: In this study, 55% of the patients achieved the target hemoglobin in phase 1 compared with 75% in phase 2 (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.0007). The hemoglobin level within the target range was sustained at 72%\u00a0\u00b1\u00a05% of patients in phase 3. The achievement rate of the target hemoglobin level increased from 56% (May 2015) to 72% (July 2018) (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.001). The proportion of patients with extreme hemoglobin declined from 10.7% in phase 1 to 6.4% in phase 2 and sustained at 8% afterward. Reducing the doses of erythropoietin stimulating agents, owing to the use of the ANM model, saved costs by approximately 11%.\n                  <\/jats:p>\n                  <jats:p>Conclusions: The ANM model was able to achieve and maintain hemoglobin levels within the target range and decrease extreme hemoglobin levels. These outcomes improved patient care by avoiding high hemoglobin (increase thrombosis, cancer recurrence, stroke, and death) and low hemoglobin (weakness, poor quality of life, and need for transfusion) levels. The ANM model was cost effective even after including the salaries of nurses. This model can be considered in other aspects of patient care in dialysis.<\/jats:p>","DOI":"10.5339\/qmj.2021.46","type":"journal-article","created":{"date-parts":[[2021,11,26]],"date-time":"2021-11-26T10:30:49Z","timestamp":1637922649000},"source":"Crossref","is-referenced-by-count":1,"title":["Effects of novel anemia nurse manager program on hemodialysis: a retrospective study from Qatar"],"prefix":"10.5339","volume":"2021","author":[{"given":"Abdullah","family":"Hamad","sequence":"first","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hany","family":"Ezzat","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarek Abdel","family":"Latif Ghonimi","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rania","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Ramadan","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia","family":"Noor","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadumo","family":"Yasin","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar","family":"Ismail","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadwa","family":"Al-Ali","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar E-mail: ahamad9@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"issue":"(2):","key":"CIT0001","series-title":"J Am Soc Nephrol","first-page":"504\u2013510","article-title":"Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey","volume":"1312","year":"2002;"},{"issue":"(2):","key":"CIT0002","series-title":"J Clin Invest","first-page":"434\u2013441","article-title":"The anemia of chronic renal failure in sheep. Response to erythropoietin-rich plasma in vivo","volume":"74","year":"1984;"},{"issue":"(3):","key":"CIT0003","series-title":"Am J Kidney Dis","first-page":"423\u2013435","article-title":"Update on anemia in ESRD and earlier stages of CKD: core curriculum","volume":"71","year":"2018;"},{"issue":"(4):","key":"CIT0004","series-title":"Semin Hematol","first-page":"261\u2013269","article-title":"Anemia in clinical practice\u2014definition and classification: does hemoglobin change with aging?","volume":"52","year":"2015;"},{"issue":"(6724):","key":"CIT0005","series-title":"Canadian Erythropoietin Study Group. BMJ","first-page":"573\u2013578","article-title":"Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving hemodialysis","volume":"300","year":"1990"},{"issue":"(2)(suppl 1):","key":"CIT0006","series-title":"Am J Kidney Dis","first-page":"14\u201318","article-title":"Improvements in quality of life following treatment with r-HuEPO in anemic hemodialysis patients","volume":"14","year":"1989;"},{"issue":"(7):","key":"CIT0007","series-title":"Ann Intern Med","first-page":"472\u2013478","article-title":"The effect of erythropoietin-stimulating agents on health-related quality of life in anemia of chronic kidney disease: a systematic review and meta-analysis","volume":"164","year":"2016"},{"issue":"(20):","key":"CIT0008","series-title":"N Engl J Med","first-page":"2085\u20132098","article-title":"CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease","volume":"355","year":"2006;"},{"issue":"(21):","key":"CIT0009","series-title":"N Engl J Med","first-page":"2019\u20132032","article-title":"TREAT Investigators. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease","volume":"361","year":"2009;"},{"issue":"(20):","key":"CIT0010","series-title":"N Engl J Med","first-page":"2071\u20132084","article-title":"CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia","volume":"355","year":"2006;"},{"issue":"(9):","key":"CIT0011","series-title":"N Engl J Med","first-page":"584\u2013590","article-title":"The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin","volume":"339","year":"1998;"},{"issue":"(3):","key":"CIT0012","series-title":"Am J Kidney Dis","first-page":"471\u2013530","article-title":"2007 update of hemoglobin target","volume":"50","year":"2007"},{"issue":"(4):","key":"CIT0013","series-title":"Kidney Int Suppl","first-page":"288\u2013291","article-title":"","volume":"2","year":"(2011)"},{"issue":"(1):","key":"CIT0014","series-title":"BMC Nephrol","first-page":"345","article-title":"Renal association clinical practice guideline on Anemia of Chronic Kidney Disease","volume":"18","year":"2017;"},{"issue":"(1):","key":"CIT0015","series-title":"Qatar Med J","first-page":"02","article-title":"Mortality of dialysis patients in Qatar: a retrospective epidemiologic study","volume":"2021","year":"2021"},{"issue":"(5)","key":"CIT0016","series-title":"J Am Heart Asso","first-page":"1\u20139","article-title":"Risk factors for heart failure in patients with chronic kidney disease: the CRIC (Chronic Renal Insufficiency Cohort) study","volume":"6","year":"2017;"},{"issue":"(20)","key":"CIT0017","series-title":"N Engl J Med","first-page":"2071-2084","article-title":"Normalization of hemoglobin level in patients with chronic kidney disease and anemia","volume":"355","year":"2006;"},{"issue":"(21)","key":"CIT0018","series-title":"New England Journal of Medicine","first-page":"2019\u20132032","article-title":"A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease","volume":"361","year":"2009;"},{"issue":"(20),","key":"CIT0019","series-title":"New Eng J Med","first-page":"2085\u20132098","article-title":"Correction of anemia with epoetin alfa in chronic kidney disease","volume":"355","year":"2006;"},{"key":"CIT0020","article-title":"The Renal Association. Clinical practice guideline Anemia of chronic kidney disease"},{"issue":"(1)","key":"CIT0021","series-title":"Ir J Med Sci","first-page":"223\u2013230","article-title":"Trends in the treatment of chronic kidney disease-associated anemia in a cohort of hemodialysis patients: the Irish experience","volume":"188","year":"2019"},{"issue":"(1)","key":"CIT0022","series-title":"J Renal Nurs","first-page":"10\u201317","article-title":"Nonmedical prescribing and anaemia management on the unit","volume":"634","year":"2014;"},{"issue":"(3)","key":"CIT0023","series-title":"Nephrology (Carlton)","first-page":"288\u2013293","article-title":"Effects of proactive iron and erythropoiesis- stimulating agent protocol implementation on achieving clinical guideline targets for Anemia in a satellite hemodialysis patient cohort","volume":"15","year":"2009;"},{"issue":"(13\u201314)6:","key":"CIT0024","series-title":"J Clin Nurs","first-page":"2535-2543","article-title":"A nurse prescriber-led protocol for Anemia management in established hemodialysis patients: a retrospective study","volume":"295","year":"2020;"},{"key":"CIT0025","first-page":"2009","article-title":"Independent evaluation of the nurse and midwife prescribing initiative"},{"issue":"(2):","key":"CIT0001","series-title":"J Am Soc Nephrol","first-page":"504\u2013510","article-title":"Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey","volume":"1312","year":"2002;"},{"issue":"(2):","key":"CIT0002","series-title":"J Clin Invest","first-page":"434\u2013441","article-title":"The anemia of chronic renal failure in sheep. Response to erythropoietin-rich plasma in vivo","volume":"74","year":"1984;"},{"issue":"(3):","key":"CIT0003","series-title":"Am J Kidney Dis","first-page":"423\u2013435","article-title":"Update on anemia in ESRD and earlier stages of CKD: core curriculum","volume":"71","year":"2018;"},{"issue":"(4):","key":"CIT0004","series-title":"Semin Hematol","first-page":"261\u2013269","article-title":"Anemia in clinical practice\u2014definition and classification: does hemoglobin change with aging?","volume":"52","year":"2015;"},{"issue":"(6724):","key":"CIT0005","series-title":"Canadian Erythropoietin Study Group. BMJ","first-page":"573\u2013578","article-title":"Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving hemodialysis","volume":"300","year":"1990"},{"issue":"(2)(suppl 1):","key":"CIT0006","series-title":"Am J Kidney Dis","first-page":"14\u201318","article-title":"Improvements in quality of life following treatment with r-HuEPO in anemic hemodialysis patients","volume":"14","year":"1989;"},{"issue":"(7):","key":"CIT0007","series-title":"Ann Intern Med","first-page":"472\u2013478","article-title":"The effect of erythropoietin-stimulating agents on health-related quality of life in anemia of chronic kidney disease: a systematic review and meta-analysis","volume":"164","year":"2016"},{"issue":"(20):","key":"CIT0008","series-title":"N Engl J Med","first-page":"2085\u20132098","article-title":"CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease","volume":"355","year":"2006;"},{"issue":"(21):","key":"CIT0009","series-title":"N Engl J Med","first-page":"2019\u20132032","article-title":"TREAT Investigators. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease","volume":"361","year":"2009;"},{"issue":"(20):","key":"CIT0010","series-title":"N Engl J Med","first-page":"2071\u20132084","article-title":"CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia","volume":"355","year":"2006;"},{"issue":"(9):","key":"CIT0011","series-title":"N Engl J Med","first-page":"584\u2013590","article-title":"The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin","volume":"339","year":"1998;"},{"issue":"(3):","key":"CIT0012","series-title":"Am J Kidney Dis","first-page":"471\u2013530","article-title":"2007 update of hemoglobin target","volume":"50","year":"2007"},{"issue":"(4):","key":"CIT0013","series-title":"Kidney Int Suppl","first-page":"288\u2013291","article-title":"","volume":"2","year":"(2011)"},{"issue":"(1):","key":"CIT0014","series-title":"BMC Nephrol","first-page":"345","article-title":"Renal association clinical practice guideline on Anemia of Chronic Kidney Disease","volume":"18","year":"2017;"},{"issue":"(1):","key":"CIT0015","series-title":"Qatar Med J","first-page":"02","article-title":"Mortality of dialysis patients in Qatar: a retrospective epidemiologic study","volume":"2021","year":"2021"},{"issue":"(5)","key":"CIT0016","series-title":"J Am Heart Asso","first-page":"1\u20139","article-title":"Risk factors for heart failure in patients with chronic kidney disease: the CRIC (Chronic Renal Insufficiency Cohort) study","volume":"6","year":"2017;"},{"issue":"(20)","key":"CIT0017","series-title":"N Engl J Med","first-page":"2071-2084","article-title":"Normalization of hemoglobin level in patients with chronic kidney disease and anemia","volume":"355","year":"2006;"},{"issue":"(21)","key":"CIT0018","series-title":"New England Journal of Medicine","first-page":"2019\u20132032","article-title":"A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease","volume":"361","year":"2009;"},{"issue":"(20),","key":"CIT0019","series-title":"New Eng J Med","first-page":"2085\u20132098","article-title":"Correction of anemia with epoetin alfa in chronic kidney disease","volume":"355","year":"2006;"},{"key":"CIT0020","article-title":"The Renal Association. 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