Implementation of a pharmaceutical care process in patients with anaemia and chronic kidney disease in treatment with erythropoiesis stimulating factors

Abstract

Background The authors have implemented a process of pharmaceutical care in the pharmacy hospital in patients with anaemia and chronic kidney disease in predialysis patients in treatment with erythropoiesis stimulating factors (ESF), due to ongoing safety reviews and reports published in the last years. Purpose Assessing the follow-up of the pharmacy care process. GRP093 Table 1 Year 2009 2010 Number of patients (Nop.) 100 79 Nop. insufficient monitoring of clinical information 31 (31%) 17 (21,5%) Number of interventions 72 24 Accepted 86% (62) 33% (8) Rejected 14% (10) 67%(16) Effective treatment 20 39 GRP093 Table 2 Number of interventions/year Reasons for intervenning 2009 2010 Recommendations Hb increases more than 2 g/dl in 4 weeks 9 1 Changing dose or frequency of ESF administration Hb>12† 29 8 Hb≥13† 0 3 Discontinuing drug, for safety Hb<11† to high doses* 34 8 Discontinuing, inefficiency Beginnings treatment Hb>10† 0 4 Not beginning *Epoetin α doses>300 units/kg/week or darbepoetin α>1, 5 εg/kg/week. †Hb levels (g/dl). Materials and methods The authors have put in place two transverse courts for 7 months in 2009 and 2010, including 100% of sensitive patients. The information was recorded in the Dispensation of Silicon (Grifols) Program. If haemoglobin (Hb) levels were maintained between 10 and 12 g/dl, treatment was considered to be effective. Results Conclusions A decrease in the number of patients treated with ESF and the need of interventions was observed. Accepted interventions were fewer also, probably due to an increase in awareness when complying with the recommendations, motivated by the follow-up. It was showed that medical checks were not too close, involving an insufficient monitoring of clinical data and difficulty to establish the effectiveness of many treatments. This data will be reported to nephrology department in order to implement possible solutions.