Pharmacist-driven interventions in patients with chronic kidney disease and end-stage renal failure

Abstract

In this thesis, we investigated how the nephrology pharmacist can improve the treatment of patients with chronic kidney disease and those on haemodialysis. First, we found that pharmacist-managed renal anaemia may improve haemoglobin outcomes and reduce ESA dose in this patient group. However, this conclusion remains uncertain, as the data are of low quality and have a high risk of bias. Second, we concluded that the long-term participation of nephrology pharmacists in multidisciplinary nephrology ward rounds maintains its efficacy and clinical relevance over five years. Third, in a study on a pharmacist intervention in patients using phosphate-binding medication (PIDO-P, Pharmacist Intervention and Dose Optimisation of Phosphate-binding medication) we discovered that at least 80% of the patients on haemodialysis using phosphate-binding medication have suboptimal health literacy. A personalised approach, taking into account health literacy, patient preferences, and individual barriers to adherence, combined with a dose reduction, can improve adherence to and reduce the pill burden of phosphate-binding medication with 35%, while maintaining stable serum phosphate concentrations. Especially patients with phosphate concentrations above 2.0 mmol/L seem to benefit from this intervention. Lastly, we demonstrated in a mixed-methods study that the PIDO-P intervention, with minor adaptations, is feasible in clinical practice.