title: Pharmaceutical care in chronic kidney disease: experience at Grenoble University Hospital from 2006 to 2010.
abstract: BACKGROUND
  Clinical pharmacists (CPs) specifically manage lab-test follow-up, adapt drug dosage according to guidelines and evaluate cardiovascular risk factors and decline in renal function. The aim of this study was to assess the impact of clinical pharmacy services in outpatient nephrology clinics.
  
  
  METHODS
  For each patient, medical history and current treatment were obtained. Each intervention was classified according to the Act-IP document of the French Society of Clinical Pharmacy. This tool contains identifications and guidelines for prevention and resolution of drug-related problems (DRPs).
  
  
  RESULTS
  From January 2008 until April 2009, 42 patients seen by the CP on at least 2 visits were included in the study. We observed 350 pharmaceutical consultations and 263 interventions. The pharmaceutical interventions concerned: untreated indication (30%), underdosage (25.9%) and overdosage (18.3%). The CP interventions consisted of: adapting doses (42.2%) and adding treatments (31.9%). The main drugs involved concerned the cardiovascular (33.1%), digestive-metabolic (28.6%) and hematopoietic (21.6%) systems.
  
  
  CONCLUSIONS
  The inclusion of a CP in the management of chronic kidney disease (CKD) patients is necessary for identification and prevention of DRPs. Besides the medical improvement of CKD patients, the CP participates in the development of prescription recommendations and therapeutic education programs for patients. Moreover, redefining roles and practices of members of a clinical team proved its efficiency in optimizing the medical care of CKD patients. Furthermore, patient entry into dialysis is postponed, which leads to a reduction in costs for health care insurance.
authors.affiliation: Nephrology Clinic, Grenoble University Hospital, Grenoble, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Belaiche
authors.forename: Thierry
authors.initials: T
authors.lastname: Romanet
authors.forename: Robert
authors.initials: R
authors.lastname: Bell
authors.forename: Jean
authors.initials: J
authors.lastname: Calop
authors.forename: Benoit
authors.initials: B
authors.lastname: Allenet
authors.forename: Philippe
authors.initials: P
authors.lastname: Zaoui
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003299:Cooperative Behavior; D004347:Drug Interactions; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D024382:Professional Role; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome