Pharmacists Can Help Identify, Treat Anemia of CKD

Anemia of chronic kidney disease is often undertreated or untreated altogether, especially among non-dialysis patients, panelists said during a session at the AMCP Nexus conference at the Gaylord National Convention Center in National Harbor, Maryland, on October 12, 2022.

The disease, which affects 6 million Americans, is associated with poor clinical outcomes and increased use of health care resources, which can increase the risk of hospitalization, cardiovascular complications, and mortality, the panelists explained. Further, anemia of CKD leads to lower hemoglobin levels, which are associated with increased morbidity and mortality among these patients.

Only about 26% to 34% of non-dialysis patients with anemia of CKD in stages 3 through 5 are treated, making it important to identify and treat. Because patients with anemia of CKD are often untreated, they frequently begin dialysis with low hemoglobin levels.

“This is often not even recognized, especially in the early stages,” said panelist Stephen Brunton, MD, FAAFP, CDCES, executive director of Primary Care Metabolic Group in Winnsboro, SC, and an associate clinical professor in the Department of Pharmacy Practice at Roseman University in Salt Lake City, Utah.

“It’s kind of 1 of those Rodney Dangerfield diseases, in that it doesn’t get any respect,” Brunton said, referencing the catchphrase of the comedian who died in 2004.

Untreated anemia of CKD is associated with lower outpatient and pharmacy expenditures but higher inpatient and total health care costs, meaning that visits to emergency departments occur more frequently and hospitals stays are often longer than for those without anemia, the panelists said.

Further, many of the treatment options available present challenges, including first-line therapy iron, which has adverse effects, most notably constipation. Subsequent therapies are recombinant human erythropoietin therapy, blood transfusions, and finally, kidney transplants.

“I think the pharmacist is well-positioned to potentially fix some of these problems,” panelist Calvin Meaney, PharmD, BCPS, a clinical associate professor at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences in New York, said during the discussion.

Pharmacists, as part of multidisciplinary teams, play both clinical and nonclinical roles in the treatment of anemia of CKD. Clinical roles can include gathering medication histories, medication adherence assessments and interventions, and medication reconciliation. Non-clinical roles can include protocol development and review, formulary reviews and recommendations, and provider education.

Additionally, Meaney explained that multidisciplinary teams have the potential to improve the survival of kidneys in patients with anemia of CKD. There are consistent cost savings when multidisciplinary teams include pharmacists as an integral part of the team, Meaney noted.

The results of several studies show pharmacist-directed care for this disease helped patients achieve their hemoglobin goals, decreased the use of erythropoiesis-stimulating agents, and helped save $3000 per patient per year, according to the panelists.

Meaney noted that the goals of the Advancing American Kidney Health Initiative Outline include reducing the number of Americans who develop kidney failure by 25% by 2030 and ensuring that 80% of new kidney patients receive home dialysis or a transplant by 2025.

“Pharmacists can integrate into these care teams and are value-added interprofessional team members,” Meaney said.

Reference

Brunton S, Meaney C. Anemia of chronic kidney disease: dialysis and non-dialysis, what does a population-based decision maker need to know? Presented at: AMCP Nexus; Gaylord National Convention Center in National Harbor, Maryland: October 12, 2022.