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

Abstract

BackgroundChronic 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.MethodsA 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.ResultsAmong 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.ConclusionsFew 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.

Use of renal risk drugs in patients with renal impairment

“…Similar results have previously been reported in other studies [1,2,5,13,19]. Thus, information is available and treatment guidelines give advice for the proper treatment of these patients [17,20].…”

“…A study conducted at five Norwegian hospitals in 2006 showed that 62 % of patients with RI had DRPs linked to renal risk drugs [1]. Several studies have shown that medication reviews conducted by clinical pharmacists in multidisciplinary teams in hospitals contribute to a reduction in DRPs [1,12,13].…”

The Role of Team-Based Care Involving Pharmacists to Improve Cardiovascular and Renal Outcomes

“…There has also been a lot of interest in anemia outcomes related to CKD utilizing team-based interventions [28,29,30]. A meta-analysis [29] reviewed the types of pharmacist interventions in the management of patients with CKD.…”

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“…pharmacist involvement at healthcare centers proved dedicated role in clinical time and in minimizing medication related discrepancies and clinical pharmacist involvement proved gradual decline in medication error, proper discharge record regarding medications and understanding about their medication in outpatients. They proved their dedicated role in critical units by providing quality of services 4 chronic disease [5][6][7] like diabetes and life threatening diseases [8][9] and by built up relationship with trust 10 to reduce drug cost 11 by facing challenging task 12 and by reducing their duration of stay in hospital 13 and by collaborative role with physician based on scientific evidence and pharmacy care planes [14][15][16][17] .…”