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Effectiveness of pharmacist intervention in patients with chronic kidney disease

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Abstract

Background Collaboration between pharmacists and physicians in the care of patients with chronic kidney disease (CKD) may improve the quality of drug dosage regimens that require adjustment according to the renal function. Objective To demonstrate that the intervention of a pharmacist in a monitoring program for patients with CKD improves the outcome of renal function in these patients. Setting A 330-bed regional referral hospital in the city of Murcia (Spain). Method All patients with CKD and taking nephrotoxic medication admitted to the internal medicine service were included in the study. Depending on the department of the hospital to which the patients were admitted, they were assigned to an intervention or control group. In the control group, the renal function at the time of admission and discharge was measured. In the intervention group, in addition to measuring kidney function at the time of admission and at discharge, the patients were followed daily and recommendation for dose adjustment were made when nephrotoxic drugs were not properly dosed. Main outcome measure Glomerular filtration rate on admission and at discharge. Results A total of 249 patients were included in the study, 124 in the control group and 125 in the intervention group. Significant differences were noted when comparing creatinine clearance (CrCl) between discharge and admission in both the control and intervention groups (5.1 ± 0.9 vs. 6.4 ± 1.0 p < 0.01). In a comparison of the observed improvement in the two groups, we found significant differences in adjusted relative CrCl according to sex, age and stage (19.9 [1.2–38.5] p < 0.05). When the disease was analyzed by stage, we observed significant differences that favored the intervention group in regards CrCl (3.1 ± 2.1 vs. 7.9 ± 3.8 p < 0.05) and relative CrCl (16.1 ± 10.3 vs. 36.6 ± 16.7) in stages 4–5. The rate of acceptance of the pharmacists’ recommendations was 74 %. Conclusion The implementation of a monitoring program for CKD patients was effective in the group in which monitoring was conducted, especially in patients with more advanced stage of CKD.

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References

  1. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adults US population: Third Natinonal Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1–12.

    Article  PubMed  Google Scholar 

  2. Levey AS, Coresh J, Balk E, et al. National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137–47.

    Article  PubMed  Google Scholar 

  3. Otero A, de Francisco ALM, Gayoso P, García F, et al. Prevalence of chronic renal disease in Spain: results of the EPIRCE study. Nefrología. 2010;30:78–86.

    PubMed  Google Scholar 

  4. Chertow GM, Lee J, Kuperman GJ, Burdick E, Horsky J, Seger DL, et al. Guided medication dosing for inpatients with renal insufficiency. JAMA. 2001;286:2839–44.

    Article  PubMed  CAS  Google Scholar 

  5. Alvarez L, Climent E, Bosacoma N, Roca S, Perdiguero M, Ordovás JP, et al. Evaluación de un programa de intervención farmacéutica en pacientes con medicamentos de riesgo renal [Evaluation of a pharmaceutical intervention program in patients with renal risk drugs]. Farm Hosp. 2009;33:147–54 Spanish.

    Article  Google Scholar 

  6. Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition. Ann Intern Med. 2002;136:604–15.

    Article  PubMed  CAS  Google Scholar 

  7. Blix HS, Viktil KK, Moger TA, Reikvam A. Use of renal risk drugs in hospitalized patients with impaired renal function-an understaimated problem? Nephrol Dial Transplant. 2006;21:3164–71.

    Article  PubMed  Google Scholar 

  8. Fabregas X, Agustí C, Gurrera T, Felip A. Evaluación de la intervención farmacéutica en un programa de reajuste de dosis en pacientes con función renal alterada [Evaluation of pharmaceutical intervention in a dose adjustment program in patients with impaired renal function]. Farm Hosp. 2003;27(Supl 1):28. Spanish.

  9. Falconnier AD, Haeffeli WE, Schonenberger RA, Surber C, Martin-Facklam M. Drug dosage in patients with renal failure optimized by inmediate concurrent feedback. J Gen Intern Med. 2001;16:369–75.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. Lavilla FJ, Ferrer A. Fracaso renal agudo: clasificación, etiopatogenia y factores pronósticos [Acute renal failure: classification, pathogenesis and prognostic factors]. Medicine. 2011;10:5348–55 Spanish.

    Google Scholar 

  11. Long CL, Raebel MA, Price DW, Magid DJ. Compliance with dosing guidelines in patients with chronic kidney disease. Ann Pharmacother. 2004;38:853–8.

    Article  PubMed  Google Scholar 

  12. Sweileh WM, Janem SA, Sawalha AF, Abu-Taha AS, Zyoud SH, Sabri IA, et al. Medication dosing errors in hospitalized patients with renal impairment: a study in Palestine. Pharmacoepidemiol Drug Saf. 2007;16:908–12.

    Article  PubMed  Google Scholar 

  13. Salomon L, Deray G, Jaundon MC, Chebaiser C, Bossi P, Launay-Vacher V, et al. Medication misuse in hospitalized patients with renal impairment. Int J Qual Health Care. 2003;15:331–5.

    Article  PubMed  CAS  Google Scholar 

  14. Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Pharmacist´s interventions in the management of patients with chronic kidney disease: a systematic review. Nephrol Dial Transplant. 2011;0:1–17.

    CAS  Google Scholar 

  15. Pai AB, Boyd A, Depczynski J, et al. Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: a 2-year, randomized, controlled study. Pharmacotherapy. 2009;29:1433–40.

    Article  PubMed  Google Scholar 

  16. Leung WY, So WY, Tong PC, et al. Effects of structured care by a pharmacist-diabetes specialist team in patients with type 2 diabetic nephropathy. Am J Med. 2005;118:1414.

    Article  PubMed  Google Scholar 

  17. Bucaloiu ID, Akers G, Bermudez MC, et al. Outpatient erythropoietin administered through a protocol-driven, pharmacist-managed program may produce significant patient and economic benefits. Manag Care Interface. 2007;20:26–30.

    PubMed  Google Scholar 

  18. Yokum D, Glass G, Cheung CF, et al. Evaluation of a phosphate management protocol to achieve optimum serum phosphate levels in hemodialysis patients. J Ren Nutr. 2008;18:521–9.

    Article  PubMed  Google Scholar 

  19. Leal S, Soto M. Chronic kidney disease risk reduction in a Hispanic population through pharmacist-based disease-state management. Adv Chronic Kidney Dis. 2008;15:162–7.

    Article  PubMed  Google Scholar 

  20. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.

    Google Scholar 

  21. Grupo de trabajo de Farmacia y Nefrología. Guía de dosificación de fármacos en insuficiencia renal. HGU Reina Sofía Murcia [Guide to drug dosage in renal failure. HGU Reina Sofia Murcia].2012.Unidad Técnica de Comunicación. Spanish.

  22. Mensa J, Gatell JM, Garcia-Sanchez JE, Letang E, Lopez-Suñe E, Marco F. Guía de terapéutica antimicrobiana [Guide antimicrobial therapy] 2011. Ed Antares. 2011.Spanish.

  23. Fichas técnicas de los medicamentos. Agencia Española de Medicamentos y Productos Sanitarios. http://www.aemps.gob.es/cima/fichasTecnicas.do?metodo=detalleForm. [Last cited 6- 2012].

  24. David N, Robert C, George M, Henry F, Michael S, The Sanford guide to Antimicrobial Therapy 2011. Forty-first edition. 2011.

  25. Machin D, Campbell M, Fayers P, Pinol A. Sample size tables for clinical studies. 2nd ed. Blackwell Science; 1997.

  26. Devesa C, Matoses C, Peral L, Sanz G, Murcia AC, Navarro A. Atención farmacéutica en pacientes ingresados con insuficiencia renal [Pharmaceutical care in patients hospitalized with kidney failure]. Farm Hosp. 2012;36:483–91 Spanish.

    Google Scholar 

  27. Montañés-Paul B, Sáez-Lleó C, Martínez-Romero G. Ajuste de dosificación de medicamentos en pacientes ancianos institucionalizados con insuficiencia renal [Adjust dosage of drugs in institutionalized elderly patients with renal insufficiency]. Farm Hosp. 2009;33:43–7 Spanish.

    Article  Google Scholar 

  28. Nyman H, Dowling T, Hudson J, Peter W, Joy M, Nolin T, et al. Comparative evaluation of the Cockcroft-Gault equation and the modification of diet in renal disease (MDRD) study equation for drug dosing. Pharmacotherapy. 2011;31:1130–44.

    Article  PubMed  Google Scholar 

  29. Stevens L, Nolin T, Richardson M, Feldman H, Lewis J, Rodby R, et al. Comparasion of drug dosing recommendations based on measured GFR and kidney function estimating equations. Am J Kidney. 2009;54:33–42.

    Article  CAS  Google Scholar 

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Acknowledgments

This study is possible due to the invaluable collaboration of the medical and nursing teams of Internal Medicine Department of the Hospital Reina Sofia of Murcia.

Funding

This study had no specific source of funding.

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Authors and Affiliations

  1. Pharmacy department, Hospital General Universitario Reina Sofía of Murcia, Av/Intendente Jorge Palacios 1, 30003, Murcia, Spain

    Aurelio Cabello-Muriel, Elena Urbieta-Sanz & Carles Iniesta-Navalón

  2. Public-health sciences department, University of Murcia, Murcia, Spain

    Juan José Gascón–Cánovas

Authors
  1. Aurelio Cabello-Muriel
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  2. Juan José Gascón–Cánovas
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  3. Elena Urbieta-Sanz
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  4. Carles Iniesta-Navalón
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Correspondence to Aurelio Cabello-Muriel.

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Cabello-Muriel, A., Gascón–Cánovas, J.J., Urbieta-Sanz, E. et al. Effectiveness of pharmacist intervention in patients with chronic kidney disease. Int J Clin Pharm 36, 896–903 (2014). https://doi.org/10.1007/s11096-014-0001-3

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  • DOI: https://doi.org/10.1007/s11096-014-0001-3

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