THE DEVELOPMENT OF A NURSE-LED RENAL ANEMIA CLINIC IN JAMAICA AND ITS OUTCOMES FROM 2020-2022 IN NON-DIALYSIS CHRONIC KIDNEY DISEASE (WCN26-AB-8482)

Chronic kidney disease (CKD) has an estimated prevalence of 15% in Jamaica, relating to the increased incidence of non-communicable diseases (NCD).  Anemia in CKD is a common, debilitating condition that requires continuous monitoring to avoid symptoms and recurrent blood transfusions. A specialized nurse-led renal anemia clinic was established at the Mandeville Regional Hospital (MRH) in 2020, the first of its kind in the Caribbean with goals of managing and educating non-dialysis CKD patients with kidney related anemia. This descriptive study aims to illustrate the features of this specialized clinic and to evaluate the initial clinical outcomes. 

This retrospective cohort of non-dialysis CKD patients attended a specialized renal anemia clinic at the Mandeville Regional Hospital located in the Southern region of Jamaica. The Consultant Nephrologist and certified Nephrology Registered Nurses (RN)from the hemodialysis unit at the hospital developed a renal anemia protocol to cover all aspects of anemia management. The Nephrologist conducted training on the use of the protocol to ensure clinical competency among the staff, including medication administration, dosing, and side effect profiles of erythropoietin (EPO) and intravenous iron.  Initial data, obtained from the medical records of 43 patients from 2020 to 2022, comprised patient demographics, CKD stage, comorbidities, medications, and laboratory results. Quantitative analyses were conducted using paired t-tests and Wilcoxon signed-rank tests to assess changes in pre- and post-intervention outcomes over four weeks.

A protocolized once-weekly renal anemia clinic became fully operational in 2020 with a team consisting of a Consultant Nephrologist, RNs and resident doctors. Initially four to six patients attended once weekly with most referrals and prescriptions from Nephrology clinic. EPO and intravenous iron were independently administered and monitored by Registered Nurses, then booked for follow-up. Of the 43 patients in the sample study; 67.4% female and 40% CKD stage 5. Nearly half (48.8%) received Erythropoietin twice weekly, while 44.2% did not receive EPO. Statistically significant improvements were observed in systolic blood pressure (mean reduction from 151 to 139 mmHg; p=0.001) and transferrin saturation (increase from 15.9% to 27.7%; p= 0.034).  Hemoglobin levels increased from 8.78 to 10.33 g/dL (p=0.324) and median ferritin rose from 119.5 ng/mL to 310 ng/mL (p=0.144), however, changes were not significant.  Similarly, C-reactive protein showed no significant difference pre and post treatment (p=0.414).

This study showed positive outcomes of CKD patients attending a newly developed nurse-led renal anemia clinic, such as better blood pressure control, a decreased need for blood transfusions, and improved quality of life. Intravenous iron was associated with significant improvement in iron stores and blood pressure control, but did not yield short-term improvements in hemoglobin or ferritin levels. These findings require further research to determine the long-term impact of nurse-led renal clinics on CKD patient health, underlining the pressing need for a more comprehensive and personalized approach. It is imperative to validate these findings with the hope of replicating this service across the island. This abstract was submitted in September 2025 for consideration into the Ministry of Health & Wellness 16th Annual National Health Research Virtual Conference, 2025 in Jamaica, however, it was not accepted.