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It should therefore be valuable to the reader, whether involved in physician education or in clinical
practice, or whether a medical student, house officer or seasoned clinician. Lukes Hospital and Texas
Heart Institute, Houston, Texas, USA). RELATED TOPICS Biomarkers Medicine Humans Europe
Calibration Clinical Sciences Prevalence Adult Glomerular Filtration Rate See Full PDF Download
PDF About Press Blog People Papers Topics Job Board We're Hiring. Nova publishes a wide array
of books and journals from authors around the globe, focusing on Medicine and Health, Science and
Technology and the Social Sciences and Humanities. Am J Health Syst Pharm. 1999, 56 (19): 1961-
1964. CAS. The detailed search results are described in Figure 1. Figure 1. However, we hypothesise
that clinical pharmacists are widely engaged in the care of CKD and ESRD patients. Conclusions All
identified studies on the involvement of clinical pharmacists in the care of CKD and ESRD patients
showed some benefit. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited. Clinical pharmacists are directly engaged
in the care of CKD and ESRD patients in different settings. Given the complexity and specifics of
drug dosing during PD, the high need for education and patient training, and the high risk of
infections (e.g., peritonitis), data specific to this patient population would be interesting and
warranted. The CKD and ESRD population can be characterised by its vulnerability and
susceptibility to drug-therapy-related morbidity due to many factors. Clinical pharmacists, as
pharmacotherapy experts, are engaged in the care of the CKD and ESRD patient population at
different stages. Discussion Our systematic review synthesises evidence on the impact of clinical
pharmacist involvement in DRPs in general, with respect to different comorbidities (e.g., anaemia
and lipid management), and regarding educational issues in CKD and ESRD patients. Furthermore,
no study of clinical pharmacy services in CKD patients investigating the slowing down of disease
progression could be identified. See Full PDF Download PDF About Press Blog People Papers
Topics Job Board We're Hiring. The weakest study design included was observational and solely
descriptive, as a high number of randomised controlled trials could not be anticipated. However,
high-quality evidence on the impact of clinical pharmacy services is limited to a few studies. We
decided to also include abstracts in our review, because we are convinced that these small studies of
the impact of clinical pharmacy on patient care contribute to the overall evidence on this topic. To
browse Academia.edu and the wider internet faster and more securely, please take a few seconds to
upgrade your browser. Interventions comprised general clinical pharmacy services with a focus on
detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on
disease management, or clinical pharmacy services with a focus on patient education in order to
increase medication knowledge. For this systematic review, two researchers independently searched
PubMed, MEDLINE and EMBASE to identify all original research articles that were published
between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European
adult general population. Conclusions Few high-quality trials addressing the benefit and impact of
clinical pharmacy services in CKD and ESRD patients have been published. Golper, MD
(Department Nephrology and Hypertension, Glickman Urologic and Kidney Institute, Cleveland
Clinic, Cleveland, Ohio, USA, and Division of Nephrology and Hypertension, Vanderbilt Center for
Kidney Diseases, Nashville, TN, USA). The reporting of clinical significance assessments for
performed interventions increases the scientific value of clinical pharmacy research, primarily by
reducing bias. The included studies report on the clinical pharmacists' involvement in the
management of anaemia, lipid disorders, cardiovascular disease, hypertension, and diabetes in CKD
or ESRD patients to various extents. Johnson, MD (Division of Renal Disease and Hypertension,
Loyola University Medical Center, Maywood, IL, USA, Division of Nephrology, Hines VA Hospital,
Hines, IL, USA, Division of Kidney Diseases and Hypertension, University of Colorado Denver,
Aurora CO, USA, and Division of Nephrology, Eastern Colorado Health Care System, Department
of Veteran Affairs, Denver, CO, USA). The purpose of this study was to summarise the available
evidence regarding the role and impact of clinical pharmacy services for these patient populations.
Patient-oriented outcomes are those that directly matter to patients, that is, those regarding longer
life and improved quality of life.
This is an Open Access article distributed under the terms of the Creative Commons Attribution
License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited. Table 4 Comprehensive listing of clinical pharmacy activities
performed in CKD and ESRD patients Full size table. Discussion Our systematic review synthesises
evidence on the impact of clinical pharmacist involvement in DRPs in general, with respect to
different comorbidities (e.g., anaemia and lipid management), and regarding educational issues in
CKD and ESRD patients. Our paper discusses current literature on health literacy in kidney
diseases. Several clinical pharmacy studies provide insights into the risk factors for DRPs. Data
about your interaction with the site is used to improve the content that we share. In addition, the
majority of the studies were published in the United States. The majority of patients with CKD are at
risk of accelerated cardiovascular disease and death. Problems with medical record discrepancies and
the accuracy of medication profiles, which are among the most commonly reported DRPs, are
further highlighted in a prospective observational study of 63 HD patients, which reports record
discrepancies in 60% of all patients. RLG was responsible for the study design, data interpretation
and review of the manuscript. Conclusions All identified studies on the involvement of clinical
pharmacists in the care of CKD and ESRD patients showed some benefit. CKD patients are at
increased risk of cardiovascular disease (CVD), which includes coronary heart disease (CHD),
cerebrovascular disease, peripheral vascular disease, and heart failure. You can change your mind at
any time by updating your settings. Guaranteeing a high level of medication knowledge may be one
strategy to increase adherence and to prevent DRPs resulting from incorrect drug use or overall
failure to take medications. We use cookies to let us know when you visit our websites, how you
interact with us, to enrich your user experience, and to customize your relationship with our website.
General study characteristics Detailed descriptions on the included studies of CKD and ESRD
patients, including relevant interventions, outcomes, and results, are shown in Tables 2 and 3,
respectively. ASHP Midyear Clinical Meeting. 2003, 38 (Dec): P-273(E)-. Note that blocking some
types of cookies may impact your experience on our websites and the services we are able to offer.
Three study types were identified, including 14 descriptive studies (DSs) (66.7%), four (randomised)
controlled (R)CTs (19%), and three before-after studies (BASs) (14.3%). A total of seven (33.3%) of
the published studies were only available as abstracts. Nova publishes a wide array of books and
journals from authors around the globe, focusing on Medicine and Health, Science and Technology
and the Social Sciences and Humanities. Schwartz Division of Nephrology, Tufts Medical Center,
Tufts University School of Medicine, Boston, Massachusetts, USA). As part of a multidisciplinary
patient care strategy, clinical pharmacy services have led to improvements in patient care. Data on
study methodology and reporting of CKD prevalence results were independently extracted by two
researchers. Assessments of the clinical significance of clinical pharmacist interventions were
performed and reported in five of 10 included studies. This multidisciplinary and multilevel
approach is underlined by all included studies. Winkler, PhD (Kidney Diseases Branch, NIDDK,
NIH, NIH, Bethesda, MD, USA). Anaemia was the most common comorbidity managed by clinical
pharmacists, and their involvement led to significant improvement in investigated disease-oriented
outcomes, for example, haemoglobin levels. Part II: Reducing drug-related problems through
application of the focused drug therapy review program. The references sections of the returned
publications and review articles were further screened for additional hits. The detailed search results
are described in Figure 1. Figure 1.
Guaranteeing a high level of medication knowledge may be one strategy to increase adherence and
to prevent DRPs resulting from incorrect drug use or overall failure to take medications. Enhancing
the involvement of clinical pharmacists may be one potential strategy. Germain, MD (New York
University School of Medicine, Division of Geriatric Medicine and Palliative Care and Division of
Nephrology, NY, USA, and Professor of Medicine Tufts University School of Medicine, Baystate
Medical Center, MA, USA). Conclusions Few high-quality trials addressing the benefit and impact
of clinical pharmacy services in CKD and ESRD patients have been published. Therefore, attention
must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are
well documented. The references sections of the returned publications and review articles were
further screened for additional hits. The medical management of predialysis and dialysis patients
involves complex and highly variable pharmacotherapy, including frequent monitoring and evaluation
to ensure optimal pharmacotherapy, adherence to medication, and control of comorbidities and other
risk factors. Further high-quality studies on the impact of clinical pharmacists on key issues such as
adherence and disease progression are thus warranted. You can change your mind at any time by
updating your settings. Problems with medical record discrepancies and the accuracy of medication
profiles, which are among the most commonly reported DRPs, are further highlighted in a
prospective observational study of 63 HD patients, which reports record discrepancies in 60% of all
patients. Table 5 Disease versus patient-oriented outcomes Full size table. With regard to the
assessment of kidney function, 67% used a Jaffe assay, wherea. Multidisciplinary health care teams
of physicians, nurses, dieticians, and clinical pharmacists share the goal of preventing disease
progression and managing comorbid conditions in CKD and ESRD patients. Authors’ original
submitted files for images Below are the links to the authors’ original submitted files for images.
Clinical pharmacists address areas requiring improvement as well as unmet DRPs responsively and
preventatively. The EU Commission takes no responsibility for any use made of the information set
out. Frequent complications and comorbidities of CKD include fluid and electrolyte abnormalities,
anaemia, secondary hyperparathyroidism and renal osteodystrophy, hypertension and
hyperlipidaemia, metabolic acidosis, and several other comorbidities involving malnutrition, pruritus
and uremic bleeding. Using data from 18 reported studies, the median (range) number of study
participants was 60 (10-408), and the median (range) study duration was six (1-32) months. The
management of patients with CKD is focused on early detection or prevention, treatment of the
underlying cause (if possible) to curb progression and attention to secondary processes that contribute
to ongoing nephron loss. Clinical pharmacists were primarily responsible for ordering and checking
laboratory values and managing independent dosing and dose modifications of erythropoiesis-
stimulating agents (ESAs) and iron within specific prescribing guidelines. Risk factors for the
development and progression of CKD include low nephron number at birth, nephron loss due to
increasing age and acute or chronic kidney injuries caused by toxic exposures or diseases (for
example, obesity and type 2 diabetes mellitus). Winkler, PhD (Kidney Diseases Branch, NIDDK,
NIH, NIH, Bethesda, MD, USA). J Am Soc Nephrol. 2003, 14 (7 Suppl 2): 76-80. Article. This
literature review aims to systematically summarise the published evidence on the role of clinical
pharmacists in the care of CKD and ESRD patients across different settings, to synthesise and
highlight findings on the impact of clinical pharmacists, their various key activities, and their main
areas of involvement, and to describe the different characteristics of clinical pharmacy services for
the CKD and ESRD patient population. We identified a higher proportion of studies investigating
disease-oriented versus patient-oriented outcomes. Blood pressure control, inhibition of the renin-
angiotensin system and disease-specific interventions are the cornerstones of therapy. This
multidisciplinary and multilevel approach is underlined by all included studies. Clinical pharmacists
are directly engaged in the care of CKD and ESRD patients in different settings. The DRPs most
frequently described in the included studies were untreated indications, super- or supratherapeutic
dosages and consequent dose adjustments, and medication record discrepancies. Townsend, MD
(Renal, Electrolyte, and Hypertension Division, University of Pennsylvania, Philadelphia,
Pennsylvania, USA).
Clinical pharmacists were primarily responsible for ordering and checking laboratory values and
managing independent dosing and dose modifications of erythropoiesis-stimulating agents (ESAs)
and iron within specific prescribing guidelines. The EU Commission takes no responsibility for any
use made of the information set out. Due to security reasons we are not able to show or modify
cookies from other domains. The weakest study design included was observational and solely
descriptive, as a high number of randomised controlled trials could not be anticipated. As part of a
multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient
care. In addition, the majority of the studies were published in the United States. Golper, MD
(Department Nephrology and Hypertension, Glickman Urologic and Kidney Institute, Cleveland
Clinic, Cleveland, Ohio, USA, and Division of Nephrology and Hypertension, Vanderbilt Center for
Kidney Diseases, Nashville, TN, USA). This literature review aims to systematically summarise the
published evidence on the role of clinical pharmacists in the care of CKD and ESRD patients across
different settings, to synthesise and highlight findings on the impact of clinical pharmacists, their
various key activities, and their main areas of involvement, and to describe the different
characteristics of clinical pharmacy services for the CKD and ESRD patient population. It will assist
clinicians considering treatment options and modality selection. (Imprint: Nova Biomedical).
Discrepancies were solved by discussion among the study authors. The authors declare that there are
no financial or other conflicts of interests with respect to the contents of the article. The most
commonly affected drugs were those used for treatment against renal bone disease and renal
osteodystrophy together with anaemia and cardiovascular drugs. RLG was responsible for the study
design, data interpretation and review of the manuscript. Studies investigating the number and type
of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate
of 79%. CKD and HD patients generally fulfil all of these criteria and therefore warrant increased
monitoring. Enhancing the involvement of clinical pharmacists may be one potential strategy. Bias
minimisation methods used during clinical significance assessments generally included a review by
independent clinical pharmacists or the achievement of consensus among the ratings of clinicians,
nephrologists and pharmacists. Progression from early to late stages of CKD generally results in the
onset of new symptoms and concomitant complications. From an evidence-based point of view,
studies investigating patient-oriented outcomes contribute more to the overall evidence and therefore
have to be weighted more heavily. We decided to also include abstracts in our review, because we are
convinced that these small studies of the impact of clinical pharmacy on patient care contribute to the
overall evidence on this topic. See Full PDF Download PDF About Press Blog People Papers Topics
Job Board We're Hiring. Our paper discusses current literature on health literacy in kidney diseases.
Additional randomised controlled trials investigating patient-oriented outcomes are needed to further
determine the role of clinical pharmacists and the benefits of clinical pharmacy services to CKD and
ESRD patients. Therefore, attention must be given to the optimisation of patient care, as gaps in the
care of CKD and ESRD patients are well documented. Edward Hartle II, MD (Metrolina
Nephrology Associates, PA, Charlotte, NC.; Clinical Assistant Professor, University of North
Carolina School of Medicine, and others). Conclusions Few high-quality trials addressing the benefit
and impact of clinical pharmacy services in CKD and ESRD patients have been published. See Full
PDF Download PDF See Full PDF Download PDF See Full PDF Download PDF Loading Preview
Sorry, preview is currently unavailable. Download citation Received: 10 January 2011 Accepted: 22
July 2011 Published: 22 July 2011 DOI: Share this article Anyone you share the following link with
will be able to read this content: Get shareable link Sorry, a shareable link is not currently available
for this article. Results The initial Medline, Embase and IPA searches yielded 339, 199, and 323
citations, respectively. Am J Health Syst Pharm. 2001, 58 (21): 2061-2065. CAS.
You can change your mind at any time by updating your settings. To browse Academia.edu and the
wider internet faster and more securely, please take a few seconds to upgrade your browser. Studies
addressing the impact of clinical pharmacy services in kidney transplantation were excluded. Data
about your interaction with the site is used to improve the content that we share. Rosas, MD (Kidney
and Hypertension Section, Joslin Diabetes Center and Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, Massachusetts, USA). Problems with medical record discrepancies
and the accuracy of medication profiles, which are among the most commonly reported DRPs, are
further highlighted in a prospective observational study of 63 HD patients, which reports record
discrepancies in 60% of all patients. See Full PDF Download PDF See Full PDF Download PDF
See Full PDF Download PDF Loading Preview Sorry, preview is currently unavailable. Otherwise
you will be prompted again when opening a new browser window or new a tab. Unspecified
categorisation systems were used in the other studies. Therefore all studies reporting on disease-
oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related
problems (DRPs) together with the physician acceptance rate, were assessed. This literature review
aims to systematically summarise the published evidence on the role of clinical pharmacists in the
care of CKD and ESRD patients across different settings, to synthesise and highlight findings on the
impact of clinical pharmacists, their various key activities, and their main areas of involvement, and
to describe the different characteristics of clinical pharmacy services for the CKD and ESRD patient
population. CKD and HD patients generally fulfil all of these criteria and therefore warrant increased
monitoring. We could not identify any studies that specifically addressed PD patients. All authors
read and approved the final manuscript. Part II: Reducing drug-related problems through application
of the focused drug therapy review program. See Full PDF Download PDF About Press Blog
People Papers Topics Job Board We're Hiring. The most common comorbidity in CKD or ESRD
patients managed by clinical pharmacists was anaemia. Authors' contributions GS was responsible for
the study design, data collection and interpretation and preparation of the manuscript. Nova
publishes a wide array of books and journals from authors around the globe, focusing on Medicine
and Health, Science and Technology and the Social Sciences and Humanities. Generally, more than
three-quarters of clinical pharmacist interventions and suggestions were accepted by physicians. The
weakest study design included was observational and solely descriptive, as a high number of
randomised controlled trials could not be anticipated. Winkler, PhD (Kidney Diseases Branch,
NIDDK, NIH, NIH, Bethesda, MD, USA). Am J Health Syst Pharm. 2001, 58 (21): 2061-2065.
CAS. It should therefore be valuable to the reader, whether involved in physician education or in
clinical practice, or whether a medical student, house officer or seasoned clinician. We could not
identify any studies showing that clinical pharmacy interventions had a negative impact on patient
care. You can download the paper by clicking the button above. Enhancing the involvement of
clinical pharmacists may be one potential strategy. To browse Academia.edu and the wider internet
faster and more securely, please take a few seconds to upgrade your browser. Please be aware that
this might heavily reduce the functionality and appearance of our site. Since these providers may
collect personal data like your IP address we allow you to block them here.
In addition, the majority of the studies were published in the United States. See Full PDF Download
PDF See Full PDF Download PDF See Full PDF Download PDF Loading Preview Sorry, preview is
currently unavailable. We identified a higher proportion of studies investigating disease-oriented
versus patient-oriented outcomes. The authors declare that there are no financial or other conflicts of
interests with respect to the contents of the article. The purpose of this study was to summarise the
available evidence regarding the role and impact of clinical pharmacy services for these patient
populations. RELATED TOPICS Biomarkers Medicine Humans Europe Calibration Clinical
Sciences Prevalence Adult Glomerular Filtration Rate See Full PDF Download PDF About Press
Blog People Papers Topics Job Board We're Hiring. Table 2 Detailed description of the included
publications on CKD patients Full size table. It will assist clinicians considering treatment options
and modality selection. (Imprint: Nova Biomedical). It should therefore be valuable to the reader,
whether involved in physician education or in clinical practice, or whether a medical student, house
officer or seasoned clinician. This project has received funding from the European Union’s Horizon
2020 research and innovation programme under grant agreement No 634086. Conclusions Few high-
quality trials addressing the benefit and impact of clinical pharmacy services in CKD and ESRD
patients have been published. Conclusions All identified studies on the involvement of clinical
pharmacists in the care of CKD and ESRD patients showed some benefit. Due to security reasons
we are not able to show or modify cookies from other domains. We identified 82 eligible
publications and included 48 publications of individual studies for the data extraction. As specialists
in pharmacotherapy, clinical pharmacists are routinely involved in patient care and interact with other
health care professionals, addressing multiple, often unmet needs for pharmacotherapy optimisation.
Table 5 Disease versus patient-oriented outcomes Full size table. To browse Academia.edu and the
wider internet faster and more securely, please take a few seconds to upgrade your browser. Several
clinical pharmacy studies provide insights into the risk factors for DRPs. See Full PDF Download
PDF See Full PDF Download PDF See Full PDF Download PDF Loading Preview Sorry, preview is
currently unavailable. However, due to our search strategy, studies explicitly addressing only these
latter aspects are not included in this systematic review. Further high-quality studies on the impact of
clinical pharmacists on key issues such as adherence and disease progression are thus warranted.
Multidisciplinary health care teams of physicians, nurses, dieticians, and clinical pharmacists share
the goal of preventing disease progression and managing comorbid conditions in CKD and ESRD
patients. Enhancing the involvement of clinical pharmacists may be one potential strategy.
Guaranteeing a high level of medication knowledge may be one strategy to increase adherence and
to prevent DRPs resulting from incorrect drug use or overall failure to take medications. Changes
will take effect once you reload the page. The majority of patients with CKD are at risk of
accelerated cardiovascular disease and death. Problems with medical record discrepancies and the
accuracy of medication profiles, which are among the most commonly reported DRPs, are further
highlighted in a prospective observational study of 63 HD patients, which reports record
discrepancies in 60% of all patients. However, we hypothesise that clinical pharmacists are widely
engaged in the care of CKD and ESRD patients. Contributing authors are Paola Romagnani,
Giuseppe Remuzzi, Richard Glassock, Adeera Levin, Kitty J.
We never show advertisements, but do share content from third-parties (e.g. videos) and use google
analytics (we do not store any personal information). See Full PDF Download PDF About Press
Blog People Papers Topics Job Board We're Hiring. However, high-quality evidence on the impact of
clinical pharmacy services is limited to a few studies. We could not identify any studies showing that
clinical pharmacy interventions had a negative impact on patient care. The purpose of this study was
to summarise the available evidence regarding the role and impact of clinical pharmacy services for
these patient populations. Schwartz Division of Nephrology, Tufts Medical Center, Tufts University
School of Medicine, Boston, Massachusetts, USA). CKD and HD patients generally fulfil all of
these criteria and therefore warrant increased monitoring. Clinical pharmacists, as pharmacotherapy
experts, are engaged in the care of the CKD and ESRD patient population at different stages. This
literature review aims to systematically summarise the published evidence on the role of clinical
pharmacists in the care of CKD and ESRD patients across different settings, to synthesise and
highlight findings on the impact of clinical pharmacists, their various key activities, and their main
areas of involvement, and to describe the different characteristics of clinical pharmacy services for
the CKD and ESRD patient population. RELATED TOPICS Biomarkers Medicine Humans Europe
Calibration Clinical Sciences Prevalence Adult Glomerular Filtration Rate See Full PDF Download
PDF About Press Blog People Papers Topics Job Board We're Hiring. Otherwise you will be
prompted again when opening a new browser window or new a tab. Given the nature of their major
responsibilities and tasks, clinical pharmacists interact with patients, physicians, and other health
professionals and share the goal of optimising pharmacotherapy and patient care. Optimal control of
hyperglycaemia, including maximal suppression of urinary albumin excretion by angiotensin-
converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in diabetic patients
with persistent microalbuminuria, and hypertension can limit progression of CKD to ESRD. For
those who progress to end-stage renal disease, the limited accessibility to renal replacement therapy
is a problem in many parts of the world. Authors’ original submitted files for images Below are the
links to the authors’ original submitted files for images. For the patient's sake, these gaps must be
addressed using all available methods. Problems with medical record discrepancies and the accuracy
of medication profiles, which are among the most commonly reported DRPs, are further highlighted
in a prospective observational study of 63 HD patients, which reports record discrepancies in 60% of
all patients. Several clinical pharmacy studies provide insights into the risk factors for DRPs. J Am
Soc Nephrol. 2003, 14 (7 Suppl 2): 76-80. Article. The weakest study design included was
observational and solely descriptive, as a high number of randomised controlled trials could not be
anticipated. Four controlled trials (three of which were randomised) revealed that clinical pharmacy
interventions had a positive impact on patient-oriented outcomes in the intervention group as
compared to the available standard of care. Conclusions Few high-quality trials addressing the
benefit and impact of clinical pharmacy services in CKD and ESRD patients have been published.
Download citation Received: 10 January 2011 Accepted: 22 July 2011 Published: 22 July 2011 DOI:
Share this article Anyone you share the following link with will be able to read this content: Get
shareable link Sorry, a shareable link is not currently available for this article. As specialists in
pharmacotherapy, clinical pharmacists are routinely involved in patient care and interact with other
health care professionals, addressing multiple, often unmet needs for pharmacotherapy optimisation.
Only four of the studies (including three controlled trials) presented data on patient-oriented
outcomes, for example, quality of life and length of hospitalisation. This is an Open Access article
distributed under the terms of the Creative Commons Attribution License ( ), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited. To browse Academia.edu and the wider internet faster and more securely, please take
a few seconds to upgrade your browser. Due to security reasons we are not able to show or modify
cookies from other domains. The majority of patients with CKD are at risk of accelerated
cardiovascular disease and death. You can download the paper by clicking the button above.