Expert Suggests That Pharmacists Should Learn More About Dialysis

Brent Miller, MD, professor, clinical medicine, Indiana University School of Medicine, spoke with Pharmacy Times about the advancing technologies in home dialysis for patients who use peritoneal dialysis patients. Miller discusses the future of dialysis, accessibility, and awareness and education in the pharmaceutical community.

“Advancing Home Dialysis with Technologies and Education”

Q: When considering technology and patient education, what are hurdles that prevent more patients, clinicians, and pharmacists from choosing home dialysis?

Brent Miller, MD: I think it is a lack of (I don’t want to say a lack of knowledge because it sounds like I’m insulting people) but I think it is a lack of awareness, in that it’s a lack of awareness also in how the field has evolved in the last 20, 30, 40 years. And so people tend to have a bias as to what they saw when they were training. And also, how we’re training pharmacists, physicians, nurses, we tend to do a lot of training on acutely ill people. So if your experience on hemodialysis and peritoneal is seeing the acutely ill people in the hospital, you might say “Gee. This doesn’t look so great.” So having more awareness of what home dialysis is and what its benefits are, what its risks are and how people do on it will help. I think that’s probably the best thing, and then incorporating that into people’s trainings would probably help.

Q: Are there adjunct technologies or medications that can impact the efficacy of at-home dialysis?

Brent Miller, MD: On the way. And you’re hearing about that immediately. One of the foremost examples in peritoneal and this was published a few months ago. If you use a medication similar to what we use for diabetes, SGLT2 inhibitors, if you use a similar block of glucose transporters in the peridium, you can increase filtration. I think there are things on the way. Also, I think with some of the diagnostic techniques hopefully evolving into developing therapies, there is increasing awareness that we can tell what is going on in patients receiving peritoneal by looking at the spent dialysis as its drained. You already have people developing early detection detectors based on that. But there’s a lot of ability to determine what’s going on with the patient by examining what’s coming out of the patient during dialysis. I think as we learn about that, there’s going to be an ability to develop pharmaceuticals and develop things that work in the peridium dialysis. Heme dialysis is a little bit different because you have the plasma ultra-filtrate. But again, that’s an opportunity to figure out how much sodium, calcium, potassium is being removed from the patient, and then all of a sudden you can develop a feedback loop that changes how much of those you remove in the dialysis treatment. I don’t have anything to tell you that is here today, tomorrow, or next week, but I think in the near future we have technologies like that.

Q: How can pharmacists be better educated about home dialysis?

Brent Miller, MD: That’s a good question. And I think it’s interesting because the Food and Drug Administration considered the dialysate that we use in peritoneal to be a pharmaceutical. Peri dialysate is actually a drug, which I was surprised to learn when I was a fellow. But I think recognizing that the portion of dialysis is, in many definitions, a pharmaceutical, and I think pharmacists learning this in their training would actually be very helpful. Many pharmacists in the hospital are involved in dialysis and some of them even compound dialysis for CVH, which is what we use in the ICU, and they’re in charge for both the supplies for hemodialysis and peritoneal in the hospital. I think there is a pathway through awareness and education in taking what some of the in-hospital pharmacists do to the out-patient pharmacists, to make that a better process.