AbstractBackgroundIn adult patients with end‐stage kidney disease (ESKD), the Kidney Disease Improving Global Outcomes (KDIGO) guideline for anemia management suggests initiation of erythropoiesis‐stimulating agents (ESA) when hemoglobin (Hb) concentration is between 9 and 10 g/dL to avoid Hb below 9 g/dL and not to exceed Hb of 11.5 g/dL. Pharmacist‐led protocol for ESA dosing was implemented at an outpatient hemodialysis unit to provide standardized dosing of ESA therapy and to attain target Hb.ObjectiveThe objective of this study was to determine the impact of a pharmacist‐directed protocol on anemia management.MethodsThe study was a single‐center, retrospective cohort comparing the 6‐month outcomes between the protocol and randomly selected historic control groups. The primary endpoint was the percentage of time in therapeutic range (TTR) of Hb range: 9.5 to 10.9 g/dL. Secondary objectives were Hb concentrations, iron indices, number of red blood cell transfusions, hospital admissions due to cardiovascular events, use of alteplase for hemodialysis catheter thrombosis, and ESA and intravenous iron dosing.ResultsOne hundred and twenty‐nine adult patients with ESKD were included with 61 patients assigned to the intervention group and 68 patients in the control group. Primary endpoint of TTR within target Hb 9.5 to 10.9 g/dL was similar between the protocol and control groups (30.7% vs 29.3%, P = .177). Median weekly doses of ESA were significantly lower in the protocol group (10 064 units vs 15 227 units, P = .035).ConclusionThis study suggests that the protocol‐driven treatment was as effective as the control with respect to TTR for target Hb values, while leading to a significant reduction in ESA doses and drug‐associated costs.