Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Nephrology
Published in: BMC Nephrology 1/2011

Open Access 01-12-2011 | Research article

Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

Authors: Gunar Stemer, Rosa Lemmens-Gruber

Published in: BMC Nephrology | Issue 1/2011

Login to get access

Abstract

Background

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations.

Methods

A literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems.

Results

Among a total of 21 studies, only four (19%) were controlled trials. The majority of studies were descriptive (67%) and before-after studies (14%). Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials) presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional pharmacotherapy, and medical record discrepancies.

Conclusions

Few high-quality trials addressing the benefit and impact of clinical pharmacy services in CKD and ESRD patients have been published. However, all available studies reported some positive impact resulting from clinical pharmacist involvement, including various investigated outcome measures that could be improved. Additional randomised controlled trials investigating patient-oriented outcomes are needed to further determine the role of clinical pharmacists and the benefits of clinical pharmacy services to CKD and ESRD patients.
Appendix
Available only for authorised users
Literature
1.
Nissenson AR, Pereira BJ, Collins AJ, Steinberg EP: Prevalence and characteristics of individuals with chronic kidney disease in a large health maintenance organization. Am J Kidney Dis. 2001, 37 (6): 1177-1183. 10.1053/ajkd.2001.24520.CrossRefPubMed
2.
3.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004, 351 (13): 1296-1305. 10.1056/NEJMoa041031.CrossRefPubMed
4.
Danovitch GM: Handbook of Kidney Transplantation. 2005, Philadelphia: Lippincott Williams & Wilkins, 4
5.
Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL: Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006, 166 (9): 955-964. 10.1001/archinte.166.9.955.CrossRefPubMed
6.
Viktil KK, Blix HS: The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008, 102 (3): 275-280. 10.1111/j.1742-7843.2007.00206.x.CrossRefPubMed
7.
Manley HJ, Cannella CA, Bailie GR, St Peter WL: Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. Am J Kidney Dis. 2005, 46 (4): 669-680. 10.1053/j.ajkd.2005.07.001.CrossRefPubMed
8.
Nissenson AR, Collins AJ, Hurley J, Petersen H, Pereira BJ, Steinberg EP: Opportunities for improving the care of patients with chronic renal insufficiency: current practice patterns. J Am Soc Nephrol. 2001, 12 (8): 1713-1720.PubMed
9.
Owen WF: Patterns of care for patients with chronic kidney disease in the United States: dying for improvement. J Am Soc Nephrol. 2003, 14 (7 Suppl 2): 76-80.CrossRef
10.
Zillich AJ, Saseen JJ, Dehart RM, Dumo P, Grabe DW, Gilmartin C, Hachey DM, Hudson JQ, Pruchnicki MC, Joy MS: Caring for patients with chronic kidney disease: a joint opinion of the ambulatory care and the nephrology practice and research networks of the American College of Clinical Pharmacy. Pharmacotherapy. 2005, 25 (1): 123-143. 10.1592/phco.25.1.123.55628.CrossRefPubMed
11.
Stemer G, Lemmens-Gruber R: Clinical pharmacy services and solid organ transplantation: a literature review. Pharm World Sci. 2010, 32 (1): 7-18. 10.1007/s11096-009-9351-7.CrossRefPubMed
12.
Possidente CJ, Bailie GR, Hood VL: Disruptions in drug therapy in long-term dialysis patients who require hospitalization. Am J Health Syst Pharm. 1999, 56 (19): 1961-1964.PubMed
13.
Castro R, Leung J, Song J, Patel R, Jobalia A: Outcomes of implementing a medication therapy management service for dialysis patients [abstract]. ASHP Midyear Clinical Meeting. 2009, p056-
14.
Lim SB, Lim GK, Khoo AL, Sivaraman P: Evaluation of the clinical and economic impact through a focused drug therapy review program in in-flight patients with renal impairment [abstract]. ASHP Midyear Clinical Meeting. 2003, 38 (Dec): P-273(E)-
15.
Patel HR, Pruchnicki MC, Hall LE: Assessment for chronic kidney disease service in high-risk patients at community health clinics. Ann Pharmacother. 2005, 39 (1): 22-27.CrossRefPubMed
16.
Lee J, Lee A, Chiao P, Chee N, Johansen K: Impact of a pharmacist's collaborative management, adherence, and medication education program (CAMP) in an ambulatory renal clinic. ASHP Midyear Clinical Meeting. 2009
17.
Tang I, Vrahnos D, Hatoum H, Lau A: Effectiveness of clinical pharmacist interventions in a hemodialysis unit. Clin Ther. 1993, 15 (2): 459-464.PubMed
18.
Kaplan B, Shimp LA, Mason NA, Ascione FJ: Chronic hemodialysis patients. Part II: Reducing drug-related problems through application of the focused drug therapy review program. Ann Pharmacother. 1994, 28 (3): 320-324.PubMed
19.
Grabe DW, Low CL, Bailie GR, Eisele G: Evaluation of drug-related problems in an outpatient hemodialysis unit and the impact of a clinical pharmacist. Clin Nephrol. 1997, 47 (2): 117-121.PubMed
20.
Erickson AL, Szumita PM, Cotugno MC: Implementation of clinical pharmacy services in a dialysis unit. Am J Health Syst Pharm. 2008, 65 (21): 2011-2013. 10.2146/ajhp070569.CrossRefPubMed
21.
Mirkov S: Implementation of a pharmacist medication review clinic for haemodialysis patients. N Z Med J. 2009, 122 (1297): 25-37.PubMed
22.
Pai AB, Boyd A, Depczynski J, Chavez IM, Khan N, Manley H: Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: a 2-year, randomized, controlled study. Pharmacotherapy. 2009, 29 (12): 1433-1440. 10.1592/phco.29.12.1433.CrossRefPubMed
23.
Pai AB, Boyd A, Chavez A, Manley HJ: Health-related quality of life is maintained in hemodialysis patients receiving pharmaceutical care: a 2-year randomized, controlled study. Hemodial Int. 2009, 13 (1): 72-79. 10.1111/j.1542-4758.2009.00328.x.CrossRefPubMed
24.
Bucaloiu ID, Akers G, Bermudez MC, Mainali R, Brown BL, Roberts SS, Hartle JE: Outpatient erythropoietin administered through a protocol-driven, pharmacist-managed program may produce significant patient and economic benefits. Manag Care Interface. 2007, 20 (6): 26-30.PubMed
25.
Joy MS, Candiani C, Vaillancourt BA, Chin H, Hogan SL, Falk RJ: Reengineering clinical operations in a medical practice to optimize the management of anemia of chronic kidney disease. Pharmacotherapy. 2007, 27 (5): 734-744. 10.1592/phco.27.5.734.CrossRefPubMed
26.
To LL, Stoner CP, Stolley SN, Buenviaje JD, Ziegler TW: Effectiveness of a pharmacist-implemented anemia management protocol in an outpatient hemodialysis unit. Am J Health Syst Pharm. 2001, 58 (21): 2061-2065.PubMed
27.
Viola RA, Abbott KC, Welch PG, McMillan RJ, Sheikh AM, Yuan CM: A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients. BMC Nephrol. 2002, 3: 9-10.1186/1471-2369-3-9.CrossRefPubMedPubMedCentral
28.
Kimura T, Arai M, Masuda H, Kawabata A: Impact of a pharmacist-implemented anemia management in outpatients with end-stage renal disease in Japan. Biol Pharm Bull. 2004, 27 (11): 1831-1833. 10.1248/bpb.27.1831.CrossRefPubMed
29.
Manley HJ, Drayer DK: Clinical pharmacy interventions reduce ambulatory hemodialysis (HD) patients cardiovascular risk [abstract]. J Am Soc Nephrol. 2004, 15: F-FC012.
30.
Walton T, Holloway KP, Knauss MD: Pharmacist-managed anemia program in an outpatient hemodialysis population. Hospital Pharmacy. 2005, 40 (12): 1051-1056.
31.
Allenet B, Chen C, Romanet T, Vialtel P, Calop J: Assessing a pharmacist-run anaemia educational programme for patients with chronic renal insufficiency. Pharm World Sci. 2007, 29 (1): 7-11. 10.1007/s11096-005-4800-4.CrossRefPubMed
32.
Sathvik BS, Mangasuli S, Narahari MG, Gurudev KC, Parthasarathi G: Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge. Indian J Pharm Sci. 2007, 69 (2): 232-239. 10.4103/0250-474X.33149.CrossRef
33.
Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD: Drug-related problems: their structure and function. DICP. 1990, 24 (11): 1093-1097.PubMed
34.
Hatoum HT, Hutchinson RA, Witte KW, Newby GP: Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction. Drug Intell Clin Pharm. 1988, 22 (3): 252-259.PubMed
35.
National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002, 39 (2 Suppl 1): 1-266.
36.
Cioffi ST, Caron MF, Kalus JS, Hill P, Buckley TE: Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic. Ann Pharmacother. 2004, 38 (5): 771-775. 10.1345/aph.1D359.CrossRefPubMed
37.
Kiel PJ, McCord AD: Pharmacist impact on clinical outcomes in a diabetes disease management program via collaborative practice. Ann Pharmacother. 2005, 39 (11): 1828-1832. 10.1345/aph.1G356.CrossRefPubMed
38.
Borenstein JE, Graber G, Saltiel E, Wallace J, Ryu S, Archi J, Deutsch S, Weingarten SR: Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy. 2003, 23 (2): 209-216. 10.1592/phco.23.2.209.32096.CrossRefPubMed
39.
Verbeeck RK, Musuamba FT: Pharmacokinetics and dosage adjustment in patients with renal dysfunction. Eur J Clin Pharmacol. 2009, 65 (8): 757-773. 10.1007/s00228-009-0678-8.CrossRefPubMed
40.
Koecheler JA, Abramowitz PW, Swim SE, Daniels CE: Indicators for the selection of ambulatory patients who warrant pharmacist monitoring. Am J Hosp Pharm. 1989, 46 (4): 729-732.PubMed
41.
Loghman-Adham M: Medication noncompliance in patients with chronic disease: issues in dialysis and renal transplantation. Am J Manag Care. 2003, 9 (2): 155-171.PubMed
42.
Metadata
Title
Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review
Authors
Gunar Stemer
Rosa Lemmens-Gruber
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2011
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/1471-2369-12-35

Other articles of this Issue 1/2011

BMC Nephrology 1/2011 Go to the issue

Research article

Predicting the risk of end-stage renal disease in the population-based setting: a retrospective case-control study

Research article

Predicting hospital cost in CKD patients through blood chemistry values

Research article

Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

Study protocol

Design and implementation of the canadian kidney disease cohort study (CKDCS): A prospective observational study of incident hemodialysis patients

Research article

Prevalence of chronic kidney disease among people living with HIV/AIDS in Burundi: a cross-sectional study

Research article

A simplified clinical prediction score of chronic kidney disease: A cross-sectional-survey study
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits