Pharmacists: Valuable Assets in Managing Patients with Chronic Kidney Disease

Patients who develop chronic kidney disease (CKD) are at risk for a number of comorbidities, including cardiovascular decline. Early and aggressive treatment can lower this risk in patients and also slow the progression of kidney dysfunction.

A team of Canadian researchers has published a study in the American Journal of Kidney Disease that looks at community pharmacy-based interventions in patients who have CKD. Their findings indicate that pharmacists can help these patients reduce their cardiovascular risk and improve control of individual risk factors.

CKD is slightly less present prevalent in Canada, with 1 in 10 Canadian nationals affected, as it is in the United States where 1 in 9 Americans are affected.

This study looks at a subset of patients who were included in a large randomized controlled trial examining a community pharmacy based case finding and intervention program.

Pharmacists who participated in this study were allowed to prescribe medication and order laboratory tests in patients who had CKD. They intervened using medication therapy management consultation during which they assessed blood pressure, waist circumference, weight, and height. They also looked at HgA_1c and lipid profiles, used a cardiovascular risk assessment calculator, and discussed the test results with patients. They contacted patients at least every 4 weeks for the following 3 months. Patients in the control arm received usual care.

The researchers noted that the patients in the intervention group had a 20% lower rate of cardiovascular events compared to patients receiving usual care. These patients improved their blood pressures, LDL-cholesterol concentrations, self-reported tobacco cessation, and hemoglobin A1c.

Using the CKD Targeted Screening Guidelines, pharmacists identified patients with CKD successfully. Forty-one percent of the patients they identified had been previously undiagnosed. This supports the pharmacist's role in case finding, and promotes early aggressive treatment.

One interesting finding was that patients who lived in urban areas had greater improvements than those who lived in rural areas. The researchers suggested that poor access to care in rural areas may explain the difference.

The researchers concluded that pharmacist interventions that are directed at patients who have or may have chronic kidney disease can greatly reduce the likelihood of cardiovascular misadventure.

Reference

Al Hamarneh YN, Tsuyuki RT, Jones CA et al. Effectiveness of Pharmacist Interventions on Cardiovascular Risk in Patients With CKD: A Subgroup Analysis of the Randomized Controlled R(x)EACH Trial. Am J Kidney Dis. 2017 Sep 11. pii: S0272-6386(17)30890-9. doi: 10.1053/j.ajkd.2017.07.012. [Epub ahead of print]