Evaluation of an anemia algorithm in chronic hemodialysis patients.

Although anemia is a common complication of chronic kidney disease, practice variability in its management continues to exist. In an effort to standardize management, the Northern Alberta Renal Program implemented an anemia algorithm, the "Anemia Protocol." A cohort design was used to evaluate the effectiveness of the "Anemia Protocol" in 98 patients three months pre-implementation and three and six months post- implementation. Clinical outcomes of hemoglobin levels, iron indices, erythropoietin and iron dosages, and its associated costs, were compared pre- and post-implementation of the algorithm. This study did not show significant change in anemia or anemia management pre- versus post-implementation of the "Anemia Protocol" in the Northern Alberta Renal Program. However, this is not to imply that algorithms are not useful in clinical settings. Anemia algorithms are invaluable in standardizing management and limiting practice variability, but to ensure that intended clinical outcomes are achieved, algorithms need to be regularly evaluated and revised as necessary.