Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Christina Hernandez


Mary Ann Apopot


The purpose of this quality improvement project was to develop an anemia management evidence-based intervention for patients receiving peritoneal dialysis (PD) and to educate staff on implementation of the anemia management protocol in a PD clinic in a southwestern county in Texas. Anemia is a common complication of chronic kidney disease (CKD) resulting from the inability of the kidneys to produce erythropoietin needed for red blood cell production. Erythropoiesis-stimulating agents such as Aranesp or Epogen may be administered to dialysis patients to stimulate erythropoiesis in the presence of kidney disease. Iron storage and iron availability remains imperative in effectively stimulating erythropoiesis for anemia management in the dialysis patient (Kliger et al, 2013). Anemia is one of the most common complications of CKD; over 48 million Americans have CKD attributing to millions with anemia of CKD origin (Centers for Disease Control and Prevention [CDC], 2017). A 6-month retrospective and current chart review of CKD patients’ undergoing PD was carried out at a PD clinic. An educational toolkit consisting of a pretest, anemia management protocol, and a post-test was developed and administered to staff. A patient educational toolkit consisting of instructional handout and a video was developed and administered to patients. Results indicated an improvement in staff knowledge about anemia management and an increase in patient hemoglobin (Hgb) and iron levels. This implementation was imperative to improving healthcare goals comparable with the Kidney Disease: Improving Global Outcomes (KDIGO) practice guidelines.