Medication-related Problems in CKD

Cardone, Katie E.; Bacchus, Shaffeeulah; Assimon, Magdalene M.; Pai, Amy Barton; Manley, Harold J.

doi:10.1053/j.ackd.2010.06.004

Cited by 75 publications

(87 citation statements)

References 30 publications

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“…Potential DRPs constitute nomenclature previously described by Strand et al and others 17,18 and include any medication with: a) a dose that exceeds upper threshold of dosing for a given eGFR, b) a non-specific recommendation for dose reduction, c) a recommendation for avoidance in CKD, d) or general caution for use in CKD. Departures from recommendations for medication dosing were detected using a medication crosswalk of all medications relevant in kidney disease which has been previously described.…”

Section: Methodsmentioning

confidence: 99%

Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

Hsu

Fink

Ginsberg

et al. 2015

American Journal of Kidney Diseases

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Background Promoting medication adherence is a recognized challenge for prescribers. In this study we examine whether lower medication adherence is associated with adverse safety events in individuals with decreased estimated glomerular filtration rate (eGFR). Study Design Cross-sectional baseline analysis of prospective cohort. Setting & Participants Baseline analysis of the Safe Kidney Care (SKC) Cohort Study, a prospective study of individuals with an eGFR < 60 mL/min/1.73m2 intended to assess the incidence of disease-specific safety events. Kidney transplant recipients were excluded. Predictor Self-reported medication adherence based on responses to 3 questions ascertaining degree of medication regimen adherence. Outcomes Adverse safety events were self-reported at baseline (Class I events) such as hypoglycemia or fall thought related to a medication, or detected incidentally during the baseline visit (Class II events), for example hypotension or hyperkalemia. Potential drugrelated problems (DRPs) were determined by analyzing participants’ medications with respect to dosing guidelines based on their screening eGFR values at the time of medication reporting. Measurements Relationship between medication adherence and disease-specific patient safety events. Results Of 293 SKC participants, 154 (53%) were classified as having lower medication adherence. After multivariable adjustment, lower medication adherence was significantly associated with a Class I or II safety event (prevalence ratio [PR], 1.21; 95% CI, 1.04–1.41) and potential DRPs (PR, 1.29; 95% CI, 1.02–1.63). Lower medication adherence was also significantly associated with multiple (≥ 2) Class I events (PR, 1.71; 95% CI, 1.18–2.49), multiple Class I or II events (PR, 1.35; 95% CI, 1.04–1.76), and multiple potential DRPs (PR, 2.11; 95% CI, 1.08–2.69) compared to those with higher medication adherence. Limitations Use of self-reported medication adherence rather than pharmacy records. Clinical relevance of detected safety events is unclear. Conclusions Lower medication adherence is associated with adverse safety events in individuals with eGFR < 60 mL/min/1.73m2.

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Section: Methodsmentioning

confidence: 99%

Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

Hsu

Fink

Ginsberg

et al. 2015

American Journal of Kidney Diseases

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“…Unlike other mobile applications, we believe that this is the only mobile application for outpatient use that supports patient-driven medication reconciliation with a feedback loop to correct errors (10,21,22). Communication of medication-related information is particularly crucial for this patient population, because patients frequently experience medication errors as a result of fragmented communication between multiple prescribers (23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Ong

Jassal

Miller

et al. 2016

CJASN

109

150

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Background and objectives Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters.Design, setting, participants, & measurements We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. ResultsIn total, 47 patients (26 men; mean age =59 years old; 33% were $65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (.80% performed $80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, 23.4 mmHg; 95% confidence interval, 25.0 to 21.8 and diastolic BP, 22.1 mmHg; 95% confidence interval, 22.9 to 21.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged.Conclusions Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial.

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“…Not surprisingly, several studies have shown a high prevalence rate of MRPs in patients undergoing maintenance dialysis (6,(10)(11)(12) (Table 2).…”

Section: Introductionmentioning

confidence: 99%

“…MRPs include adverse drug events and inappropriate under-and overuse of drug therapy (6). Dialysis-dependent patients have many of the risk factors consistently associated with a high likelihood of MRPs (2,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

Pai

Cardone

Manley

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryPatients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model.

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Medication-related Problems in CKD

Cited by 75 publications

References 30 publications

Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

Integrating a Smartphone–Based Self–Management System into Usual Care of Advanced CKD

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients

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