Identification of drug-related problems in ambulatory chronic kidney disease patients: a 6-month prospective study.
BACKGROUND
Drug-related problems (DRPs) are common in chronic kidney disease (CKD) patients. We developed a 2-step consultation including a clinical pharmacist (CP) session and a nephrologist conventional care consultation to explore the feasibility of a pilot drug-oriented disease management program in controlling iatrogenic side effects.


METHODS
Drug inventory was estimated by a CP before each nephrology consultation. CP interventions were based on the French Society of Clinical Pharmacy intervention tools.


RESULTS
In this 6-month prospective study, 67 CKD patients were enrolled: 77% with stage 3 or 4 CKD (by Kidney Disease Improving Global Outcomes criteria), 66% males, 76% with diabetes, median age 70 years (range 59-75), with a mean 2.6 ± 1.2 comorbidities and 10 ± 3.5 medications. We registered 142 DRPs, in 93% of patients, which mainly concerned untreated indications (31.7%) and incorrect dosages (19%). The most frequent pharmaceutical interventions concerned addition of drug (34%) and adaptation of dose (25.5%). The main drugs involved concerned the cardiovascular (33%), digestive-metabolic (26.9%) and hematopoietic (19.9%) systems. DRPs correlated significantly with a higher number of medications (p=0.049) and with older patient age (p=0.0027). Furthermore, patients' knowledge was evaluated in 41 patients (61%) by the CP with a systematic questionnaire. Three at-risk situations were described: 80.5% of patients interviewed were unaware of the beneficial impact of their treatment, 85% were not aware of medical situations at risk and 68% declared self-medication habits.


CONCLUSIONS
A formatted CP evaluation coupled with a renal consultation was able to detect a higher level of DRPs, to reinforce educational messages and to propose immediate changes in the therapeutic project.
Nephrology Clinic, Grenoble University Hospital, Grenoble, France.
Stéphanie
S
Belaiche
Thierry
T
Romanet
Benoît
B
Allenet
Jean
J
Calop
Philippe
P
Zaoui
D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D015897:Comorbidity; D003299:Cooperative Behavior; D064420:Drug-Related Side Effects and Adverse Reactions; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control*; D033183:Interdisciplinary Communication; D008297:Male; D059065:Medication Reconciliation; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D010865:Pilot Projects; D019338:Polypharmacy; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012651:Self Medication; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors