Effects of pharmacist participation in chronic kidney disease (CKD) network and CKD manual distribution on drug-related kidney injury.

Abstract

Renin-angiotensin system (RAS) inhibitors carry a risk of normotensive ischemic acute kidney injury in dehydration and concurrent nonsteroidal anti-inflammatory drug (NSAID) use. Although the estimated number of patients with chronic kidney disease (CKD) is 20000, Fujieda, Japan, has only three nephrologists. On 25 March 2016, we reorganized the CKD network to include pharmacists and distributed a CKD manual. We assessed effects of pharmacist participation in the CKD network and CKD manual distribution on patient hospitalizations because of drug-related kidney injury. Changes in the prevalence of RAS inhibitor-related estimated glomerular filtration rate (eGFR) declines of greater than or equal to 30% and hyperkalemia of greater than or equal to 6.0mEq/L in 129 hospitalized CKD patients, drug prescriptions of 14150 hospitalized patients, and annual medical checkup data in 36042 citizens were investigated before and after pharmacist participation. After pharmacist participation, patient hospitalizations due to RAS inhibitor-related eGFR declines decreased (71.4% to 38.1%, P=.03) and hyperkalemia declined (38.1% to 9.5%, P=.03). Pharmacist participation influenced the decrease in RAS inhibitor-related eGFR declines (P=.03). NSAID prescriptions decreased (13.4% to 11.8%, P=.003) and acetaminophen prescriptions increased (6.6% to 8.0%, P=.002) among 14150 hospitalized patients, whereas RAS inhibitor prescriptions decreased (43.2% to 39.4%, P=.002) among 6930 hospitalized patients with eGFR less than 60mL/min/1.73m2 . A significant number of citizens shifted from CKD stage G3a-3b to G1-2. Pharmacist participation in the CKD network and CKD manual distribution decreased both hospitalizations due to RAS inhibitor-related kidney injury and citizens with CKD stage G3a-3b.