A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients.
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.
Viola
Rebecca A
RA
Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC, USA. rebecca.viola@na.amedd.army.mil
Abbott
Kevin C
KC
Welch
Paul G
PG
McMillan
Robichaud J
RJ
Sheikh
Aatif M
AM
Yuan
Christina M
CM
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
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D011725:Pyridines; D019821:Simvastatin; C086276:cerivastatin