Medication Compliance When Treating CKD is Crucial, UPMC Health Plan Expert Says

In an interview with Pharmacy Times^®, Sarah Nelson, PharmD, clinical pharmacist with UPMC Health Plan, discusses her role as a pharmacist when helping members manage and treat their chronic kidney disease (CKD). Her main role focuses on helping to ensure medication compliance among members, but she also provides education on members’ medication and disease states. Nelson also highlights the FDA’s recent approval of semaglutide to include members with type 2 diabetes who have CKD, noting that the approval can help them better manage their blood sugar while reducing their risk of kidney failure.

Pharmacy Times: Can you introduce yourself?

Sarah Nelson, PharmD: Hi, my name is Sarah Nelson. I'm a clinical pharmacist in care management at UPMC Health Plan.

Pharmacy Times: As a pharmacist, what is your role when helping patients manage/treat their chronic kidney disease (CKD)?

Nelson: So, as a pharmacist at UPMC Health Plan, I work with patients to ensure compliance with their prescribed medications, especially the medications that they're prescribed for common comorbidities with CKD, like hypertension, diabetes, hyperlipidemia. And so, when discussing medication compliance with patients, I also review medication-specific and disease state education, in addition to the patients' education, I also complete medication profile reviews to identify potential drug-related problems, in addition to monitoring labs for potential dose adjustments. And then lastly, I work with providers to identify patient populations with suboptimal medication use, and recommend opportunities to optimize medication therapy, and again, really look at medications that may need that renal dose adjustment.

Pharmacy Times: As far as medication management, what are the biggest challenges and how might you address them?

Nelson: Another challenge specifically related to CKD would just be the patient awareness and understanding of CKD as a chronic condition that can impact the patient throughout their lifespan. And I do try to address these challenges with the patient, obviously, direct patient counseling is very important [with] helping them understand [AEs] as well as what to do if they think that they're experiencing an [AE] or not tolerating the medication. [I] review any potential opportunities for cost savings, and then lastly, referring the patient to any appropriate care management or community-based services to provide them with additional assistance depending on their need.

Pharmacy Times: What are some key points you emphasize when counseling patients with CKD on their medications?

Nelson: When I counsel patients, I really try to emphasize that medication compliance, noting to patients that their medications may not make them feel any different, but really, the benefit of the medication is happening inside their bodies. And specifically for CKD, we're really looking to see that slowed progression there. So, again, encouraging patients to address any concerns that they have with their medications with their [health care provider] before they make any changes on their own. Also, advising patients to discuss what over the counter medications they're using or potentially interested in using before they start them.

And then, some general education points that I think are important—not necessarily [specific to] CKD, but they also play a big role here for patients—would be counseling them to avoid [nonsteroidal anti-inflammatory drugs] or those nonsteroidal medications, following a low-sodium diet, ensuring that they're staying adequately hydrated, smoking cessation, staying up to date on recommended immunizations, being as physically active as they can, following a healthy diet. And then, really depending on how the conversation is going, it's really just [about] focusing the education on things that the patient is in control of and providing them the support that they need to achieve their goals.

Pharmacy Times: Recently, the FDA approved an indication for semaglutide to include CKD. What are the implications of this, and how might this expand treatment options for patients?

Nelson: So, patients with type 2 diabetes and CKD are at high risk for cardiovascular disease and the progression of or development of kidney failure. Type 2 diabetes is the most frequent cause of CKD, so the FDA approval of semaglutide (Ozempic; Novo Nordisk) is exciting, because this medication can help patients manage their blood sugar, their blood glucose, while also hopefully reducing the risk of kidney failure.

It is important to note that this approval is for patients who already have type 2 diabetes who also have CKD really looking to reduce the risk of worsening kidney disease or cardiovascular death. So, it may not be an appropriate treatment for all patients with CKD. And then, just to highlight some other additional benefits of the [glucagon-like peptide-1] medication class, would be helping with weight loss, those cardiovascular benefits, and then blood glucose control, especially in patients with later-stage CKD who might not be able to take other medications like metformin or another drug class, like the [sodium-glucose cotransporter 2] inhibitors.

Pharmacy Times: What are some gaps in CKD research that you hope will be addressed in the future?

Nelson: I definitely would like to see further research related to CKD pharmacotherapy in patients, with type 1 diabetes, and a little bit more focus on patients in the later stages of their CKD. And then, even going beyond that, [I would also like to see] optimal management of diabetes in patients that do progress to kidney failure and need to start dialysis or undergo transplantation.

Pharmacy Times: Any final or closing thoughts?

Nelson: I think something that's important as we kind of look forward is to really try to increase the awareness and education, just in general regarding kidney health...identifying and controlling risk factors as well as engaging patients in directed education and counseling. And then, earlier detection and timely referrals to health management and other lifestyle programs [can] work together with the medications to help patients slow that progression.