Chronic Hemodialysis Patients. Part II: Reducing Drug-Related Problems through Application of the Focused Drug Therapy Review Program

Kaplan, Barbara; Shimp, Leslie A.; Mason, Nancy A.; Ascione, Frank J.

doi:10.1177/106002809402800304

Cited by 31 publications

(36 citation statements)

References 5 publications

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“…Several studies have shown that dialysis-dependent patients are at an especially elevated risk of medication-related problems, medication discrepancies, and drug-record discrepancies. 3,4,6,7,15,16,[20][21][22][23] In the current 2-year study, the mean number of medication discrepancies identified through ambulatory medication reconciliation was 1.31 per hemodialysis patient and 0.65 per reconciliation process. A previous study reported drug record discrepancies of 1.7 (SD 1.3) per patient when information gathered from the patient was compared with information in an electronic medical record.…”

Section: Discussionmentioning

confidence: 99%

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Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Wilson

Ladda

Tran

et al. 2017

CJHP

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Background: Ambulatory medication reconciliation can reduce the frequency of medication discrepancies and may also reduce adverse drug events. Patients receiving dialysis are at high risk for medication discrepancies because they typically have multiple comorbid conditions, are taking many medications, and are receiving care from many practitioners. Little is known about the potential benefits of ambulatory medication reconciliation for these patients. Objectives: To determine the number, type, and potential level of harm associated with medication discrepancies identified through ambulatory medication reconciliation and to ascertain the views of community pharmacists and family physicians about this service. Methods: This retrospective cohort study involved patients initiating hemodialysis who received ambulatory medication reconciliation in a hospital renal program over the period July 2014 to July 2016. Discrepancies identified on the medication reconciliation forms for study patients were extracted and categorized by discrepancy type and potential level of harm. The level of harm was determined independently by a pharmacist and a nurse practitioner using a defined scoring system. In the event of disagreement, a nephrologist determined the final score. Surveys were sent to 52 community pharmacists and 44 family physicians involved in the care of study patients to collect their opinions and perspectives on ambulatory medication reconciliation. Results: Ambulatory medication reconciliation was conducted 296 times for a total of 147 hemodialysis patients. The mean number of discrepancies identified per patient was 1.31 (standard deviation 2.00). Overall, 30% of these discrepancies were deemed to have the potential to cause moderate to severe patient discomfort or clinical deterioration. Survey results indicated that community practitioners found ambulatory medication reconciliation valuable for providing quality care to dialysis patients. Conclusions: This study has provided evidence that ambulatory medication reconciliation can increase patient safety and potentially prevent adverse events associated with medication discrepancies.

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Section: Discussionmentioning

confidence: 99%

“…On average, these patients are taking 10 to 12 medications per day and 19 pills per day. [6][7][8][9] Because they have many comorbidities, their drug regimens change frequently. It has been reported that an average of 4.7 prescribers are involved in the care of each dialysis patient.…”

Section: Résumémentioning

confidence: 99%

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Wilson

Ladda

Tran

et al. 2017

CJHP

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“…Our study suggests that uremia resulting from 5/6th nephrectomy does not significantly impact the overall hepatic clearance of an Oatp substrate. chronic kidney disease; uremia; cytochrome P-450; hepatic transport; Mrp2; Oatp; sodium fluorescein PATIENTS WITH END-STAGE RENAL disease (ESRD) receiving dialysis take on average 12 medications to manage the complications of their renal failure and their comorbid disease, which places them at a substantial risk for adverse drug events (8,12,13). Currently, modifications in drug dosing to improve safety for ESRD patients have largely been confined to those medications excreted renally.…”

mentioning

confidence: 99%

Effects of chronic kidney disease on liver transport: quantitative intravital microscopy of fluorescein transport in the rat liver

Ryan

Dunn

Decker

2014

American Journal of Physiology-Regulatory, Integrative and Comp

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Ryan JC, Dunn KW, Decker BS. Effects of chronic kidney disease on liver transport: quantitative intravital microscopy of fluorescein transport in the rat liver. Am J Physiol Regul Integr Comp Physiol 307: R1488 -R1492, 2014. First published October 22, 2014 doi:10.1152/ajpregu.00371.2014.-Clinical studies indicate that hepatic drug transport may be altered in chronic kidney disease (CKD). Uremic solutes associated with CKD have been found to alter the expression and/or activity of hepatocyte transporters in experimental animals and in cultured cells. However, given the complexity and adaptability of hepatic transport, it is not clear whether these changes translate into significant alterations in hepatic transport in vivo. To directly measure the effect of CKD on hepatocyte transport in vivo, we conducted quantitative intravital microscopy of transport of the fluorescent organic anion fluorescein in the livers of rats following 5/6th nephrectomy, an established model of CKD. Our quantitative analysis of fluorescein transport showed that the rate of hepatocyte uptake was reduced by ϳ20% in 5/6th nephrectomized rats, consistent with previous observations of Oatp downregulation. However, the overall rate of transport into bile canaliculi was unaffected, suggesting compensatory changes in Mrp2-mediated secretion. Our study suggests that uremia resulting from 5/6th nephrectomy does not significantly impact the overall hepatic clearance of an Oatp substrate. chronic kidney disease; uremia; cytochrome P-450; hepatic transport; Mrp2; Oatp; sodium fluorescein PATIENTS WITH END-STAGE RENAL disease (ESRD) receiving dialysis take on average 12 medications to manage the complications of their renal failure and their comorbid disease, which places them at a substantial risk for adverse drug events (8,12,13). Currently, modifications in drug dosing to improve safety for ESRD patients have largely been confined to those medications excreted renally. This has likely improved the safety of these medications for the ESRD population, yet it remains an incomplete approach, since it does not include the hepatically metabolized medications. This oversight is significant because evidence increasingly indicates that hepatic drug metabolism and transport are reduced in patients with [14][15][16][17][18][19][20][21][22][25][26][27][28]30). Consequently, administering the full dose of a hepatically metabolized medication may place an ESRD patient at similar risk for an adverse drug event as administering the full dose of a renally eliminated medication.Experimental evidence suggests multiple mechanisms by which uremic solutes might influence hepatic drug disposition (20,25). Studies from the Pichette laboratory demonstrated that the activity and expression of cytochrome P-450 (CYP450) was reduced in the 5/6th nephrectomy (5/6N) rat model of chronic renal failure (6, 10, 11). Their work elucidated a direct role for uremic solutes with the observation that CYP450 activity and expression were reduced in primary rat hepatocytes incubated wit...

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“…135,136 Pharmacists' interventions in patients undergoing hemodialysis have been shown to be clinically significant, with most of the pharmacists' recommendations being accepted. 87,89,90 In one study, pharmacists' interventions were independently evaluated by two different clinical pharmacists with expertise in nephrology pharmacotherapeutics. Thirty-five percent of interventions were related to preservation of major-organ function, 62% improved the quality of care to acceptable standards, and 90% resulted in positive patient outcomes.…”

Section: Management Of Patients Undergoing Dialysismentioning

confidence: 99%

“…Drugrelated problems associated with inappropriate dosing occur in individuals with renal insufficiency or failure, and pharmacists have documented positive outcomes through drug management and other innovative programs for this population. [83][84][85][86][87][88][89][90][91][92][93][94][95][96] Documented Impact…”

Section: Pharmacy' S Positionmentioning

confidence: 99%

Healthy People 2010: Challenges, Opportunities, and a Call to Action for America's Pharmacists

et al. 2004

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Chronic Hemodialysis Patients. Part II: Reducing Drug-Related Problems through Application of the Focused Drug Therapy Review Program

Abstract: The FDTRP has been shown to be useful in the care of chronic hemodialysis patients. In addition, the pharmacist was able to provide clinically important recommendations in a closely monitored patient population.

Cited by 31 publications

References 5 publications

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

Effects of chronic kidney disease on liver transport: quantitative intravital microscopy of fluorescein transport in the rat liver

Healthy People 2010: Challenges, Opportunities, and a Call to Action for America's Pharmacists

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