Role of Pharmacist Intervention in the Management of Anemia Associated with Chronic Kidney Diseases at the Hemodialysis Setting

Abstract

Background:The potential impact of pharmacist interventions could improve health outcomes of patients with anemia. However, this attempt has not been documented yet in the developing countries. Aim of the study is to investigate the effect of pharmacist interventions in optimizing management of anemia associated with chronic kidney disease. Methods: An interventional randomized control trial was carried out on 120 anemic patients on hemodialysis for eight months. The impact of the pharmacist's interventions in optimizing anemia management to reach hemoglobin target were investigated. Data were analyzed by GraphPad Prism version 8.2.1. Results: During 16-week period, 1646 interventions and recommendations were performed. The interventions were at the physician, patients, drugs, hospital and administrative level. At the physician level a total of 180 (10.9%) recommendations were proposed, at the drug level, the pharmacist provided 595 (36.1%) interventions which were mainly related to erythropoietin and iron dose adjustment. At the patient and the hospital level 734 (44.6%) and 137 (8.3%) interventions have been made respectively. Hemoglobin level increased significantly to (11.25 ± 2.29) after 16-weeks in interventional group (p-value <0.5), while in non-interventional group it was increased to (9.99 ± 2.54) at 16 th week although the change was significant compare to the baseline level but it has not reached the target hemoglobin level. In the interventional group 39 (65%) patients reached the target hemoglobin while it was 25 (41.6%) in non-interventional group with a significant difference between both groups (p-value=0.017). Conclusion: In conclusion the implementation of pharmacist intervention in patients with chronic kidney disease-associated anemia improved hemoglobin level and healthcare outcomes.

How can pharmacists contribute to anaemia management? A review of literature and exploratory study on pharmacists' role in anaemia

“…The majority of short-listed articles were from the United States (n:5), 28 , 29 , 30 , 31 , 32 followed by two articles from Japan, 33 , 34 and the rest from Canada, 35 France, 36 Iraq, 37 Jordan, 38 Malaysia, 39 Nepal, 40 Peru, 41 Tanzania, 42 and Thailand. 43 The most common designs (n:6) used in the articles identified, were retrospective studies involving reviewing medication charts to evaluate the impact of pharmacists' roles in anaemia management.…”

“…43 The most common designs (n:6) used in the articles identified, were retrospective studies involving reviewing medication charts to evaluate the impact of pharmacists' roles in anaemia management. 28 , 30 , 31 , 32 , 33 , 35 Three included studies that utilised randomised controlled trials to investigate the effect of pharmacists' interventions in anaemia management associated with chronic kidney disease, 37 among continuous ambulatory peritoneal disease patients, 39 and in iron deficiency anaemia. 38 Two articles utilised before-after design, one of the articles evaluating the impact of pharmacists after providing an educational training programme for patients, 36 and the other article was a pre-post evaluation of training implementation to support pharmacists in providing point-of-care testing, including anaemia.…”

the-effect-of-pharmacists-interventions-on-anaemia-management-among-continuous-ambulatory-peritoneal-dialysis-patients-in-terengganu-tertiary-hospital

“…Available studies reported the benefits and impact of pharmacy services in anaemia management. A study conducted showed that active participation of pharmacists in anaemia management significantly improved mean Hb level [8,16]. Other studies reported that pharmacist education program led to significant Hb improvement.…”

The Effectiveness of Pharmacist Interventions in the Management of Patient with Renal Failure: A Systematic Review and Meta-Analysis

“…In these locations, pharmaceutical services mainly include dispensing of medicines, patient education about their usage, management with psychotropic drugs, or control of medicine storage conditions. The impact of clinical pharmacy services on care of inpatients with CKD has yet to be established [ 26 , 31 , 32 , 34 , 36 , 55 ]. Therefore the proposed pharmacist-led interventions in these trials could deviate from real-world situations.…”