Assessment of risk factors for increased resource utilization in kidney transplantation

Vranian, Steven C; Covert, Kelly L.; Mardis, Caitlin R.; McGillicuddy, John W.; Chavin, Kenneth D.; DuBay, Derek A.; Taber, David J.

doi:10.1016/j.jss.2017.09.037

Cited by 5 publications

(7 citation statements)

References 12 publications

(19 reference statements)

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“…Medication errors and medication safety are major issues in transplant recipients, as the majority are receiving more than 10 medications and 20 doses per day; these agents are known to have substantial toxicities and numerous drug interactions. Nonadherence, adverse drug events, and errors can have a major influence on clinical outcomes after transplant . The results of this study demonstrated reduced medication errors (mainly in discrepancies within the electronic medical record) and improved patient‐reported adherence, with low rates of newly reported adverse drug events.…”

Section: Discussionmentioning

confidence: 63%

“…Nonadherence, adverse drug events, and errors can have a major influence on clinical outcomes after transplant. [37][38][39][40] The results of this study demonstrated reduced medication errors (mainly in discrepancies within the electronic medical record) and improved patient-reported adherence, with low rates of newly reported adverse drug events. These findings offer promise that educational and technology interventions, driven by transplant pharmacists, may improve medication-related outcomes.…”

Section: Discussionmentioning

confidence: 66%

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Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Taber

Gebregziabher

Posadas

et al. 2018

J Am Coll Clin Pharm

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Introduction: Health disparities in African-American (AA) kidney transplant recipients compared with non-AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity. Objective: To assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients. Methods: Prospective, pharmacist-led, technology-aided, 6-month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one-year post transplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent-to-treat analyses, with differences assessed between AA and non-AA recipients. Results: The participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs. end of study 68%, p=0.054) and hemoglobin A1c <7% (baseline 33% vs. end of study 47%, p=0.061). AAs demonstrated a significant reduction from baseline in systolic blood pressure (−0.86 mmHg per month, p=0.026), which was not evident in non-AAs (−0.13 mmHg per month, p=0.865). Mean HgbA1c decreased from baseline in the overall group (−0.12% per month, p=0.003), which was similar within AAs (−0.11% per month, p=0.004) and non-AAs (−0.14% per month, p=0.029). There were no changes in low-density lipoproteins, triglycerides, or high-density lipoproteins over the course of the study. Medication errors were significantly reduced and self-reported medication adherence significantly improved over the course of the study. Conclusion: These results demonstrate the potential efficacy of a pharmacist-led, technology-aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients. (ClinicalTrials.gov NCT02763943)

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 66%

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Taber

Gebregziabher

Posadas

et al. 2018

J Am Coll Clin Pharm

Self Cite

View full text Add to dashboard Cite

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“…Thirty-seven studies (46%) were conducted utilising data from a single centre, 28 (35%) utilised data from a national database, 11 (14%) used data from multiple centres while the remaining 5 (6%) focused on provincial data. Other than database review or medical chart abstraction, five studies included patient surveys (Flythe et al, 2017;Jasinski et al, 2018;Shi et al, 2018;Vranian et al, 2018;Wjayantii et al, 2019). Prevalence of readmission is summarised in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Factors associated with readmission in chronic kidney disease: Systematic review and meta‐analysis

Low

Lai

Manias

2022

Journal of Renal Care

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BackgroundRisk factors associated with all‐cause hospital readmission are poorly characterised in patients with chronic kidney disease.ObjectiveA systematic review and meta‐analysis were conducted to identify risk factors and protectors of hospital readmission in chronic kidney disease.Design, Participants & MeasurementsStudies involving adult patients were identified from four databases from inception to 31/03/2020. Random‐effects meta‐analyses were conducted to determine factors associated with all‐cause 30‐day hospital readmission in general chronic kidney disease, in dialysis and in kidney transplant recipient groups.ResultsEighty relevant studies (chronic kidney disease, n = 14 studies; dialysis, n = 34 studies; and transplant, n = 32 studies) were identified. Meta‐analysis revealed that in both chronic kidney disease and transplant groups, increasing age in years and days spent at the hospital during the initial stay were associated with a higher risk of 30‐day readmission. Other risk factors identified included increasing body mass index (kg/m2) in the transplant group, and functional impairment and discharge destination in the dialysis group. Within the chronic kidney disease group, having an outpatient follow‐up appointment with a nephrologist within 14 days of discharge was protective against readmission but this was not protective if provided by a primary care provider or a cardiologist.ConclusionRisk‐reduction interventions that can be implemented include a nephrologist appointment within 14 days of hospital discharge, rehabilitation programme for functional improvement in the dialysis group and meal plans in the transplant group. Future risk analysis should focus on modifiable factors to ensure that strategies can be tested and implemented in those who are more at risk.

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“…Medication-related problems are common among kidney transplant recipients. The continued management of comorbidities, a substantial new medication regimen (eight drugs per day, on average) and intensive follow-up care constitute a significant challenge for these patients 2 3. After transplantation, medication discrepancies can lead to fluctuating levels of immunosuppression, which in turn may result in transplant rejection, infection, and/or drug toxicity 4.…”

Section: Introductionmentioning

confidence: 99%

A pharmacist-led intervention to improve kidney transplant recipient outcomes and identify patients at risk of highly variable trough tacrolimus levels: a cohort study

Daré

Laval

et al. 2023

Eur J Hosp Pharm

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ObjectivesGiven the positive impact of appropriate medication management on graft outcome and therefore of patient survival and graft function, the pharmacist’s role in the kidney transplantation team has evolved over recent decades. The primary objective of this study was to determine whether pharmacist-led intervention after kidney transplantation is associated with a lower graft rejection rate and intra-patient variation in tacrolimus trough concentrations (Cmin). The study’s secondary objective was to develop a questionnaire to identify patients at risk for highly variable Cmin.MethodsWe retrospectively analysed kidney transplant recipients at Rennes University Hospital (France) between January 2013 and December 2020. Patients who received pharmacist-led education (intervention group, n=139) were compared with patients who did not (control group, n=131), according to graft survival at 1 year post-transplant, coefficient of variation (%CV) for the tacrolimus Cmin, age, sex, length of hospital stay post-transplantation, body mass index, and Charlson Comorbidity Index. In the intervention group, a questionnaire assessing patient knowledge was introduced to compare scores with the %CV.ResultsIn the intervention group, 1 year post-transplant graft survival was higher (95.7% vs 88.5%, p=0.0289) and patients had fewer variabilities in Cmin. The %CV was correlated with questionnaire scores (r=−0.9758, p<0.0001).ConclusionsPharmacist-led interventions may have contributed to improved graft survival and patient management of immunosuppressants. Because %CV correlates with the patient questionnaire score, its introduction could be useful in identifying kidney transplant patients who would benefit most from a pharmacist-led patient education.

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Assessment of risk factors for increased resource utilization in kidney transplantation

Cited by 5 publications

References 12 publications

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Factors associated with readmission in chronic kidney disease: Systematic review and meta‐analysis

A pharmacist-led intervention to improve kidney transplant recipient outcomes and identify patients at risk of highly variable trough tacrolimus levels: a cohort study

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