Evaluation of a chronic kidney disease risk assessment service in community pharmacies

Gheewala, Pankti A.; Peterson, Gregory M.; Zaidi, Syed Tabish Razi; Jose, Matthew; Castelino, Ronald L.

doi:10.1111/nep.13247

Cited by 4 publications

(7 citation statements)

References 25 publications

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have used point-of-care technology to evaluate CKD risk assessment in community pharmacies; however, this study was the first to evaluate the relative strength of risk factors in predicting and identifying CKD issues. 21 Moreover, 72% of patients had their medication regimen reviewed by a pharmacist. This is instrumental in helping to identify and differentially diagnose medication-related causes of CKD, in ruling out acute kidney injury requiring immediate medical attention, and identifying other drug-related problems.…”

Section: Discussionmentioning

confidence: 99%

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Community Pharmacy-Based eGFR Screening for Early Detection of CKD in High Risk Patients

Papastergiou

Donnelly

Li³

et al. 2020

Can J Kidney Health Dis

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Background: Chronic kidney disease (CKD) is a condition presenting with long-term slow progression of structural and/or functional damage to the kidneys. Early detection is key to preventing complications and improving outcomes. Point-of-care estimated glomerular filtration rate (eGFR) screening technology allows for detection of abnormal kidney function in the community pharmacy setting. Objective: To evaluate the effectiveness of a community pharmacist-directed point-of-care screening program and to identify the prevalence of CKD in high-risk patients. Design: Quantitative observational. Setting: Four community pharmacies in British Columbia over a 6-month period. Patients: In all, 642 participants with at least one CKD risk factor were identified and screened. Mean age was 60 years and females accounted for 55% of the study population. Measurements: Serum creatinine was measured from peripheral blood using the HeathTab® screening system (Piccolo® Renal Function Panel with the Piccolo® blood chemistry analyzer). eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Methods: Patients provided a sample of peripheral blood via a self-administered finger-prick and analytical data to assess kidney function was reported including blood urea nitrogen (BUN), serum creatinine, and electrolytes by the HealthTab® screening system. Once results were available, the pharmacist conducted a comprehensive medication review with the patient and recommended certain follow-up actions if appropriate. Results: CKD risk factor included diabetes (30%), hypertension (45%), cardiovascular disease (12%), family history of kidney disease (13%), age over 55 years (68%), and an Aboriginal, Asian, South Asian, or African ethnic background (82%). A total of 11.5% of patients had eGFR values lower than 60 mL/min (abnormal renal function) and 34% had an eGFR between 60 and 89 mL/min (minimally reduced renal function). Overall pharmacists’ actions included blood pressure check (98%), education on CKD and risk factors (89%), medication review (72%), and physician follow-up (38%). Limitations included lack of follow-up beyond the 3-month study period prevented medical confirmation of CKD and limited the ability to quantify the impact of pharmacist interventions on the clinical outcomes of patients with low eGFR. Conclusion: These results illustrate the prevalence of abnormal renal function among undiagnosed, high-risk patients in the community. Pharmacists, as the most accessible healthcare practitioners, are ideally positioned to utilize novel point-of care technologies to improve access to CKD screening, facilitate follow-up, and increase awareness around the importance of early detection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Community Pharmacy-Based eGFR Screening for Early Detection of CKD in High Risk Patients

Papastergiou

Donnelly

Li³

et al. 2020

Can J Kidney Health Dis

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Section: Introductionmentioning

confidence: 94%

“…The use of POCT by pharmacists has been previously evaluated and demonstrated in diabetes and in patients taking warfarin 23–25. Small observational studies from the Netherlands, Spain and Canada also explored the effectiveness of using POCT in pharmacies for early detection of CKD and identification of nephrotoxic medication use,26–28 while an Australian study evaluated the feasibility of a pharmacist-led CKD screening 29…”

Section: Introductionmentioning

confidence: 99%

“…Our pilot work in an Australian context involving 24 community pharmacies and 389 patients found that 52% of screened participants had moderate or high risk of developing CKD, but only 53% of them subsequently had kidney function tests via a pathology provider. 29 The pilot work highlighted issues such as poor referral uptake by GPs, lack of service remuneration and absence of objective measurements for kidney function. 29 30 To address these challenges, the proposed trial comprises an improved model of care that involves a more effective collaboration between pharmacists and GPs, including incentives for both, and implementing a POCT for objective measurements of kidney function.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol

Tesfaye,

Krass,

Sud

et al. 2023

BMJ Open

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IntroductionChronic kidney disease (CKD) is increasingly recognised as a growing global public health problem. Early detection and management can significantly reduce the loss of kidney function. The proposed trial aims to evaluate the impact of a community pharmacy-led intervention combining CKD screening and medication review on CKD detection and quality use of medicines (QUM) for patients with CKD. We hypothesise that the proposed intervention will enhance detection of newly diagnosed CKD cases and reduce potentially inappropriate medications use by people at risk of or living with CKD.Methods and analysisThis study is a multicentre, pragmatic, two-level cluster randomised controlled trial which will be conducted across different regions in Australia. Clusters of community pharmacies from geographical groups of co-located postcodes will be randomised. The project will be conducted in 122 community pharmacies distributed across metropolitan and rural areas. The trial consists of two arms: (1) Control Group: a risk assessment using the QKidney CKD risk assessment tool, and (2) Intervention Group: a risk assessment using the QKidney CKD plus Point-of-Care Testing for kidney function markers (serum creatinine and estimated glomerular filtration rate), followed by a QUM service. The primary outcomes of the study are the proportion of patients newly diagnosed with CKD at the end of the study period (12 months); and rates of changes in the number of medications considered problematic in kidney disease (number of medications prescribed at inappropriate doses based on kidney function and/or number of nephrotoxic medications) over the same period. Secondary outcomes include proportion of people on potentially inappropriate medications, types of recommendations provided by the pharmacist (and acceptance rate by general practitioners), proportion of people who were screened, referred, and took up the referral to visit their general practitioners, and economic and other patient-centred outcomes.Ethics and disseminationThe trial protocol has been approved by the Human Research Ethics Committee at the University of Sydney (2022/044) and the findings of the study will be presented at scientific conferences and published in peer-reviewed journal(s).Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12622000329763).

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Interdisciplinary Care Model: Chronic Kidney Disease and Oral Health

2018

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Evaluation of a chronic kidney disease risk assessment service in community pharmacies

Cited by 4 publications

References 25 publications

Community Pharmacy-Based eGFR Screening for Early Detection of CKD in High Risk Patients

Community Pharmacy-Based eGFR Screening for Early Detection of CKD in High Risk Patients

Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol

Interdisciplinary Care Model: Chronic Kidney Disease and Oral Health

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