Effectiveness of pharmacist intervention in patients with chronic kidney disease
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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.
KeywordsChronic kidney disease Dose adjustment Hospitalized patients Internal medicine department Nephrotoxic drugs Pharmacist intervention Renal function Spain
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.
This study had no specific source of funding.
- 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.CrossRefGoogle 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.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
- 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.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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 25.Machin D, Campbell M, Fayers P, Pinol A. Sample size tables for clinical studies. 2nd ed. Blackwell Science; 1997.Google Scholar
- 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