Effectiveness of pharmacist intervention in patients with chronic kidney disease

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.