Inappropriate Prescribing of Erythropoiesis-Stimulating Agents for Kidney Disease Patients

In 2007, after randomized-trial results were published that showed adverse effects of using erythropoiesis-stimulating agents (ESAs) to normalize hemoglobin levels in patients with chronic kidney disease (CKD), the FDA directed clinicians to aim for hemoglobin levels of 10 to 12 g/dL during ESA therapy. But how well did physicians heed that advice?

To answer this question, Veterans Administration researchers evaluated ESA prescribing during 2009 for about 600 non–dialysis-dependent CKD patients who fell into two groups: In one group, patients were followed in pharmacist-managed ESA clinics, where pharmacists had authority to dose and monitor ESAs; in the other group, physicians managed ESA therapy.

Compared with physician-managed patients, ph…