title: A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients.
abstract: BACKGROUND
  There is little information on how target lipid levels can be achieved in end stage renal disease (ESRD) patients in a systematic, multidisciplinary fashion.
  
  
  METHODS
  We retrospectively reviewed a pharmacist-directed hyperlipidemia management program for chronic hemodialysis (HD) patients. All 26 adult patients on chronic HD at a tertiary care medical facility were entered into the program. A clinical pharmacist was responsible for laboratory monitoring, patient counseling, and the initiation and dosage adjustment of an appropriate 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) using a dosing algorithm and monitoring guidelines. The low-density lipoprotein (LDL) cholesterol goal was leq; 100 mg/dl. A renal dietitian provided nutrition counseling and the nephrologist was notified of potential or existing drug interactions or adverse drug reactions (ADRs). Patients received a flyer containing lipid panel results to encourage compliance. Data was collected at program initiation and for 6 months thereafter.
  
  
  RESULTS
  At the start of the program, 58% of patients were at target LDL cholesterol. At 6 months, 88% had achieved target LDL (p = 0.015). Mean LDL cholesterol decreased from 96 +/- 5 to 80 +/- 3 mg/dl (p < 0.01), and mean total cholesterol decreased from 170 +/- 7 to 151 +/- 4 mg/dl (p < 0.01). Fifteen adjustments in drug therapy were made. Eight adverse drug reactions were identified; 2 required drug discontinuation or an alternative agent. Physicians were alerted to 8 potential drug-drug interactions, and appropriate monitoring was performed.
  
  
  CONCLUSIONS
  Our findings demonstrate both feasibility and efficacy of a multidisciplinary approach in management of hyperlipidemia in HD patients.
authors.affiliation: Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC, USA. rebecca.viola@na.amedd.army.mil
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Viola
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
authors.forename: Paul G
authors.initials: PG
authors.lastname: Welch
authors.forename: Robichaud J
authors.initials: RJ
authors.lastname: McMillan
authors.forename: Aatif M
authors.initials: AM
authors.lastname: Sheikh
authors.forename: Christina M
authors.initials: CM
authors.lastname: Yuan
mesh_terms: D000465:Algorithms; D004347:Drug Interactions; D005240:Feasibility Studies; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006937:Hypercholesterolemia / Q000097:blood / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010607:Pharmacy Service, Hospital; D011725:Pyridines / Q000627:therapeutic use*; D012016:Reference Values; D006435:Renal Dialysis; D012189:Retrospective Studies; D019821:Simvastatin / Q000627:therapeutic use*; D013223:Statistics as Topic
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D011725:Pyridines; D019821:Simvastatin; C086276:cerivastatin