Community pharmacist targeted screening for chronic kidney disease.

Abstract

More than 1 in 10 adults in Canada is living with chronic kidney disease (CKD),1 defined as a reduction in kidney function (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) or markers of kidney damage (albuminuria ≥3 mg/mmol or abnormalities in urine sediment or renal imaging) for more than 3 months.2 Individuals with CKD require more intensive follow-up due to their reduced renal function, increased cardiovascular risk and multiple associated comorbidities.3 Early detection can help optimize the treatment, prevent or slow the progression of the disease and ultimately improve the quality of life of patients with CKD.4-6 Early stages of CKD are often asymptomatic, making preventive efforts difficult. Indeed, Mitra and Bradley7 identified that a large proportion of patients in the community are underdiagnosed and undertreated for CKD. As such, the use of comprehensive evidence-based guidelines to aid in targeted screening, early detection and management of such patients has been recommended.1 The CKD Clinical Pathway was developed to provide guidance on these issues in this high-risk population.8 The CKD Clinical Pathway is an online tool modeled after the successful National Institute for Health and Care Excellence (NICE) clinical pathways. It was developed by a team of stakeholders that included nephrologists, pharmacists, primary care physicians, nurses, other health care professionals, information technology specialists, web developers and designers to aid in the diagnosis, management and referral of adults with CKD in the community. The content in the CKD Clinical Pathway is evidence based and combines a group of national and international guidelines.2,9-14 This ensures that the recommendations are relevant and harmonized across Canada. More information on the CKD Clinical Pathway is available at www.ckdpathway.ca. Pharmacists are frontline health care professionals who see patients with, and at risk of, CKD frequently and therefore could systematically identify these individuals and assist in their management. Moreover, pharmacists’ scope of practice has expanded in Alberta, allowing them to order and view laboratory tests. As such, we undertook this study to evaluate pharmacists’ application of the CKD Clinical Pathway in the screening and identification of patients with CKD, particularly those with previously unrecognized CKD.