Renal failure is one of the major health problems in the world. Any gaps in the patient care may affect the patient adherence and quality of life. As part of a multi-disciplinary patient care strategy, clinical pharmacy service has led to improvement in patient care. The purpose of the study is to evaluate the role of medication reconciliation in renal failure patients and to observe the effect of medication alert card and patient counseling in medication reconciliation. In control, Drug Related Problems (DRPs) were identified only by chart review. In test group, one arm containing patients with DRPs were identified using medication reconciliation alone and in second arm, patient counseling and medication alert card was used in addition to reconciliation. Patient data were recorded on a standard template obtained from The Manitoba Renal Program (Canada). DRPs were recorded. Knowledge was assessed with a questionnaire before and after counseling and it was quantified. More number of DRPs was identified by means of medication reconciliation. Patient counseling and medication alert card had a significant role in medication reconciliation. The study was statistically significant with P<0.05. Medication reconciliation in renal failure helps to identify more number of drug related problems. Patient counseling and medication alert card have effectively improved the effect of reconciliation in renal failure patients and thus could improve clinical outcomes and quality of life.