Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review

Abstract

Background Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients. Given recent practice developments (e.g. polypharmacy reviews and pharmacist prescribing) there is a need to provide a current synthesis of the evidence base for characteristics and outcomes of clinical pharmacy practice in chronic kidney disease patients. Aim of the review To critically appraise, synthesise and present the available evidence of the characteristics (structures and processes) and outcomes of clinical pharmacy practice as part of the multidisciplinary care of patients with chronic kidney disease. Method PubMed, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus were searched for peer reviewed papers using improved search strategy. Included studies were quality assessed using Downs and Black tool for controlled studies and the mixed methods appraisal tool for all controlled and non-controlled studies. Data were extracted and synthesised using a narrative approach. Screening, quality assessment and data extraction were performed by two independent researchers. Ethics approval was not required. Results Forty-seven studies were identified from a variety of countries, with 31 based in a hospital setting. Controlled study designs were employed in 20, with only ten of these using randomisation. Resources available for service provision were poorly reported in all papers. Positive impact on clinical outcomes included significant improvement in parathyroid hormone, blood pressure, haemoglobin and creatinine clearance. Pharmacists identified 5302 drug related problems in 2933 patients and made 3160 recommendations with acceptance rates up to 95%. Impact on humanistic outcomes was shown through improvement in health related quality of life and patient satisfaction. Economic benefits arose from significant cost savings through pharmaceutical care provision. Conclusion While there is some evidence of positive impact on clinical, humanistic and economic outcomes, this evidence is generally of low quality and insufficient volume. While the existing evidence is in favour of pharmacists’ involvement in the multidisciplinary team providing care to patients with chronic kidney disease, more high-quality research is warranted. Electronic supplementary material The online version of this article (10.1007/s11096-019-00816-4) contains supplementary material, which is available to authorized users.

Drug-Related Problems and Pharmacist Interventions in Inpatients with Chronic Kidney Disease

“…According to a systematic review (Raiisi et al, 2019) of clinical pharmacy practice in the care of chronic kidney disease patients, various pharmacist activities in different studies included modifying drug doses, requesting and monitoring laboratory parameters, assessing the appropriateness of medications, performing medication reconciliation, patient medication counseling, and adherence motivation, and managing speci ic CKD complications. In our study, some of the activities like drug dose modi ications, patient medication counseling and monitoring laboratory parameters were done by the pharmacist.…”

Potentially inappropriate prescribing in older adults with advanced chronic kidney disease

“…Studies suggest that involving pharmacists in the care of patients with CKD improves prescribing practices [ 10 ]. However, most studies have focused on prescribing in the acute care hospital setting or hemodialysis population, or have involved recommendations from a community pharmacist and have not examined the impact of pharmacists as part of the ambulatory kidney care team [ 10 , 14 – 16 ]. With this in mind, we conducted a retrospective cohort study to examine potentially inappropriate prescribing in older patients with advanced CKD followed in multidisciplinary kidney clinics and examined if inappropriate prescribing was reduced following the introduction of pharmacists into the kidney clinics.…”

Nephrology practice and research network opinion paper: Pharmacists' perspectives on the Advancing American Kidney Health initiative

“… a This list is not inclusive of all studies of pharmacist‐based care in patients with kidney disease, which is beyond the scope of this opinion paper. Refer to systematic reviews of this topic by Raiisi and colleagues and Salgado and colleagues 44,45 …”

“…In patients with kidney diseases, clinical pharmacists' interventions reduced hospital admissions, length of hospital stay, and incidence of ESKD or death 44 . A more recent systematic review demonstrated pharmacist services continue to positively impact disease state management (anemia, blood pressure, and mineral bone disorder) with increasing focus on MTP identification, improvement in health‐related quality of life, patient satisfaction, and cost savings 45 . Studies evaluating multidisciplinary teams with pharmacists vs nephrologist care alone in patients with CKD have demonstrated decreased hospitalizations and mortality 17 .…”