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Nephrology Dialysis Transplantation 2007 22(Supplement 4):iv31-iv36; doi:10.1093/ndt/gfm163
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. for Permissions, please email: journals.permissions@oxfordjournals.org

Development and exploitation of a clinical decision support system for the management of renal anaemia

Eric J. Will1, Donald Richardson2, Cae Tolman1,3 and Cherry Bartlett1

1Department of Renal Medicine, St James's University Hospital, Leeds, UK, 2Department of Renal Medicine, York Hospitals NHS Trust, York, UK and 3Medical Adviser, Amgen Australia Pty Ltd.

Correspondence and offprint requests to: Dr E. J. Will, FRCP, Department of Renal Medicine, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Email: eric.will{at}leedsth.nhs.uk



  Abstract

The management of renal disease and its comorbidities lends itself to the use of computer-assisted decision support systems (CDSS); however, several issues with regard to computer-based treatment algorithms remain unresolved. This review examines the development and application of a clinical decision support system for the management of renal anaemia. Studies illustrate the dependence of outcome on prespecified haemoglobin (Hb) intervention values (thresholds) and the use of a computer program containing treatment algorithms to manage Epoetin doses and iron supplements. Early experimental studies and randomized, controlled studies are discussed that examine the use of clinical measures of haemodialysis (HD) and peritoneal dialysis (PD), including Hb, serum ferritin and red cell hypochromia or transferrin saturation. Broad flexibility of erythropoietic agent, dosing, route of administration and frequency has been built into computer programs written for clinical and experimental application. While further studies with the system are anticipated, predictability and sustainability of Hb outcomes and a capacity to manage large patient groups have been demonstrated and wider application appears promising.

Keywords: anaemia management; erythropoietin; haemodialysis; haemoglobin; iron deficiency; peritoneal dialysis


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