The Efficacy and Safety of a Personalized Protocol Designed to Balance Hemoglobin Levels in Hemodialysis Patients as Led by Nephrology Clinical Nurse Specialists: An Intervention Study

Abstract

Background: The ongoing clinical challenge of managing hemoglobin levels in chronic dialysis patients is exacerbated by the gap between growing patient needs and the limited availability of nephrologists. Clinical nurse specialists (CNSs) have been contributing to the successes of modern healthcare systems across Europe, but there is a limited understanding of specific mechanisms by which CNSs can support and improve patient outcomes in renal diseases. Objectives: Responding to previous calls, this intervention study evaluated the role of nephrology CNSs in dialysis patient care. Methods: This intervention study employed erythropoiesis-stimulating agents (ESAs) to investigate whether a personalized, tailored protocol led by nephrology CNSs could improve the hemoglobin balance compared to the conventional standard of care led by nephrologists. Thirty-nine patients who met the inclusion criteria with a preset hemoglobin value between 10.5–12 g/dL completed the study. Results: There were no significant differences in hemoglobin levels between patients managed by nephrologists and those overseen by CNSs. Hemoglobin variability remained unchanged after protocol implementation, while key dialysis quality indicators (e.g., iron saturation, urea reduction) remained within safety limits. Notably, ESA-related medical adjustments were significantly reduced, requiring half as many modifications over 12 study points. Conclusions: A CNS-led personalized protocol effectively maintained dialysis patient parameters within established safety thresholds. These findings reinforce the critical role of CNSs in enhancing the efficiency, effectiveness, and safety of hemoglobin management in this high-risk population. Policy implications are discussed.