scholarly journals Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

2021 ◽  
Vol 18 (8) ◽  
pp. 4370
Author(s):  
A Kim ◽  
Hayeon Lee ◽  
Eun-Jeong Shin ◽  
Eun-Jung Cho ◽  
Yoon-Sook Cho ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Management ◽  
Medication Use ◽  
Potentially Inappropriate Medications ◽  
Management Service ◽  
Ckd Stage ◽  
The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

scholarly journals Collaborative Pharmacist–physician Medication Management for the Elderly With Chronic Kidney Disease and Polypharmacy

2020 ◽  
Author(s):  
A Jeong Kim ◽  
Hayeon Lee ◽  
Eun Jeong Shin ◽  
Eun Jung Cho ◽  
Yoon Sook Cho ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Management ◽  
Medication Use ◽  
Potentially Inappropriate Medications ◽  
Management Service ◽  
Drug Related Problems ◽  
Inappropriate Medications

Abstract Background: Inappropriate polypharmacy is likely in older adults with chronic kidney disease owing to the considerable burden of comorbidities. We aimed to evaluate the impact of a collaborative pharmacist–physician geriatric medication management service on the quality of medication use. Methods: We retrospectively reviewed the medical records of patients who received the geriatric medication management service in ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The quality of medication use was evaluated based on the numbers of medications and potentially inappropriate medications. We also evaluated the types of drug-related problems identified during medication management service and pharmacists’ interventions. Results: Drug use quality was assessed in 87 of 95 patients who received the service. After the provision of medication management service, the total numbers of medications and potentially inappropriate medications decreased from 13.5 ± 4.3 to 10.9 ± 3.8 (p < 0.001) and from 1.6 ± 1.4 to 1.0 ± 1.2 (p<0.001), respectively. Furthermore, the numbers of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped” (111, 31.4%).Conclusions: Polypharmacy and potentially inappropriate medications were prevalent in older adults with chronic kidney disease, and geriatric medication management service involving a collaboration between pharmacists and physicians improved the quality of medication use in this population.

scholarly journals INDICATORS OF QUALITY OF LIFE OF PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE II-IV

2020 ◽  
Vol 16 (3) ◽  
pp. 39-43
Author(s):  
I.O. Dudar ◽  
O.M. Loboda ◽  
І.V. Krasyuk ◽  
V.V. Alekseeva
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Diseases ◽  
Stage Ii ◽  
Disease Stage ◽  
Ckd Stage ◽  
The Impact

Relevance. Chronic diseases have a long duration and a rather slow progression, and people who have such diseases want not only to live longer but also to live better. Therefore, quality of life (QOL) is one of the most important health issues for the treatment of chronic diseases. Objective: to determine the features of QOL in patients with chronic kidney disease (CKD) stage II-IV. Materials and methods. In 171 patients with CKD of II-IV centuries, in addition to general clinical and laboratory studies, QOL was studied using a questionnaire to assess the quality of life of SF-36. The questionnaire contains 36 questions of the main module, supplemented by multi-point scales aimed specifically at patients with CKD. The answers were evaluated in points - from 0 to 100. The higher the score, the better the patient's QOL. The total components were also calculated: physical total component, mental total component, total points. The obtained research data were subjected to statistical processing, which included parametric (t-test for samples with unrelated variants) and non-parametric (Mann-Whitney method) methods, correlation analysis was used. Results. Most QOL indicators worsen significantly with the progression of CKD. The indicators of total QOL, as well as the indicator "the impact of the disease on everyday life" are most significantly reduced. Age correlates as much as possible with most indicators of QOL in patients with CKD. With age, the QOL of patients decreases, but the manifestations of the disease increase and the mental and physical condition of patients deteriorate. QOL parameters are probably directly and moderately correlated with hemoglobin levels. Most QOL parameters are significantly moderately correlated with systolic blood pressure and diastolic blood pressure. It is assumed that the correction of anemia and blood pressure control, in addition to a positive effect on disease progression and the occurrence and development of complications, will also improve QOL. There were no significant differences in the assessment of QOL in men and women. Conclusions. QOL indicators decrease with the progression of CKD. Age, hemoglobin level, blood pressure affect QOL.

scholarly journals IMPACT OF PHARMACIST LED INTERVENTION IN IMPROVING MEDICATION KNOWLEDGE AMONG CHRONIC KIDNEY DISEASE PATIENTS: A PRELIMINARY STUDY

2020 ◽  
pp. 25-27
Author(s):  
GANESH SRITHERAN PANEERSELVAM
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Management ◽  
Knowledge Score ◽  
Knowledge Assessment ◽  
Preliminary Evaluation ◽  
Improve Medication Adherence ◽  
Medication Knowledge ◽  
Ckd Stage ◽  
The Impact

Objective: This study aims to evaluate the impact of pharmacist-led medication management clinics in improving medication knowledge among chronic kidney disease (CKD) patients. Methods: This was a retrospective study using a convenient sampling method. All CKD patients age 18 y above with complete pre and post knowledge assessment record were included. The pre-knowledge assessment was done at baseline while the post-assessment was done after a few sessions of medication knowledge teaching done by the clinical pharmacist using medication knowledge assessment form. Demographics data and pre-post knowledge scores were retrieved from patient’s electronic medical record system. All data were analysed using the Statistical Package for Social Sciences (SPSS) version 24. Results: The study shows a total of 13 patients, with the majority being Malay, male with a median age of 60. 84.6% of the patients were consuming more than 5 medications. While 53.9% of patients fall into CKD stage 4 and 5. Patient’s knowledge towards medications improved significantly with an increase in the median pre-knowledge score of 13 to post knowledge score of 18 (p<0.05) after completion of the session. Conclusion: From this preliminary evaluation, pharmacist-led medication management clinic resulted in significant improvement of medication knowledge which is further expected to improve medication adherence and delay the disease progression

scholarly journals Impaired kidney function is associated with lower quality of life among community-dwelling older adults

2020 ◽  
Vol 20 (S1) ◽  
Author(s):  
Rada Artzi-Medvedik ◽  
◽  
Robert Kob ◽  
Paolo Fabbietti ◽  
Fabrizia Lattanzio ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Chronic Kidney Disease ◽  
Health Status ◽  
Kidney Disease ◽  
Physical Performance ◽  
Community Dwelling ◽  
The Impact ◽  
Community Dwelling Older Adults

Abstract Background Quality of life (QoL) refers to the physical, psychological, social and medical aspects of life that are influenced by health status and function. The purpose of this study was to measure the self-perceived health status among the elderly population across Europe in different stages of Chronic Kidney Disease (CKD). Methods Our series consisted of 2255 community-dwelling older adults enrolled in the Screening for Chronic Kidney Disease (CKD) among Older People across Europe (SCOPE) study. All patients underwent a comprehensive geriatric assessment (CGA), including included demographics, clinical and physical assessment, number of medications taken, family arrangement, Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale, History of falls, Lower urinary tract symptoms, and Short Physical Performance Battery (SPPB). Estimated glomerular filtration rate (eGFR) was calculated by Berlin Initiative Study (BIS) equation. Quality of life was assessed by Euro Qol questionnaire (Euro-Qol 5D) and EQ-Visual Analogue Scale (EQ-VAS). The association between CKD (eGFR < 60, < 45 ml or < 30 ml/min/1.73m2) and low EQoL-VAS was investigated by multivariable logistic regression models. Results CKD was found to be significantly associated with low EQoL-VAS in crude analysis (OR = 1.47, 95%CI = 1.16–1.85 for eGFR< 60; OR = 1.38, 95%CI = 1.08–1.77 for eGFR< 45; OR = 1.57, 95%CI = 1.01–2.44). Such association was no longer significant only when adjusting for SPPB (OR = 1.20, 95%CI = 0.93–1.56 for eGFR< 60; OR = 0.87, 95%CI = 0.64–1.18 for eGFR< 45; OR = 0.84, 95%CI = 0.50–1.42), CIRS and polypharmacy (OR = 1.16, 95%CI = 0.90–1.50 for eGFR< 60; OR = 0.86, 95%CI = 0.64–1.16 for eGFR< 45; OR = 1.11, 95%CI = 0.69–1.80) or diabetes, hypertension and chronic obstructive pulmonary disease (OR = 1.28, 95%CI = 0.99–1.64 for eGFR< 60; OR = 1.16, 95%CI = 0.88–1.52 for eGFR< 45; OR = 1.47, 95%CI = 0.92–2.34). The association between CKD and low EQoL-VAS was confirmed in all remaining multivariable models. Conclusions CKD may significantly affect QoL in community-dwelling older adults. Physical performance, polypharmacy, diabetes, hypertension and COPD may affect such association, which suggests that the impact of CKD on QoL is likely multifactorial and partly mediated by co-occurrent conditions/risk factors.

scholarly journals HUBUNGAN KOMPLIKASI INTRA HEMODIALISIS DENGAN KUALITAS HIDUP PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) STAGE V YANG MENJALANI HEMODIALISIS DI RUANG HEMODIALISA BRSU TABANAN TAHUN 2017

2018 ◽  
Vol 2 (1) ◽  
pp. 9
Author(s):  
Kadek G Pebriantari ◽  
IGA Puja Astuti Dewi
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Significant Relationship ◽  
Chi Square ◽  
Cross Sectional ◽  
Probability Sampling ◽  
Ckd Stage ◽  
Non Parametric

ABSTRAKLatar Belakang. Hemodialisis aman dan bermanfaat untuk pasien, namun bukan berarti tanpa efek samping. Berbagai komplikasi dapat terjadi pada saat pasien menjalani hemodialisis. Komplikasi ini dapat mengakibatkan timbulnya masalah baru yang lebih kompleks, yaitu dapat mempengaruhi kualitas hidup bahkan menimbulkan kematianTujuan. Untuk mengetahui hubungan komplikasi intra hemodialisis dengan kualitas hidup  pada pasien Chronic Kidney Disease (CKD) Stage V yang menjalani hemodialisis.Metode. Jenis penelitian adalah analitik korelasional dengan pendekatan cross-sectional. Sampel pada penelitian ini berjumlah 166 responden diambil dengan teknik non probability sampling yaitu total sampling. Pengumpulan data menggunakan kuesioner dan lembar observasi,dianalisa dengan uji non parametric (Chi Square).Hasil. Rata – rata jumlah komplikasi intra hemodialisis adalah kurang dari dua komplikasi (sedikit komplikasi). Hipertensi intra hemodialisis adalah komplikasi terbanyak yang ditemukan (52,3%). Kejang dan penurunan kesadaran merupakan komplikasi yang tidak pernah dialami oleh responden selama penelitian (0%).Kualitas hidup pasien CKD stage V yang menjalani HD di BRSU Tabanan masuk dalam kategori kualitas baik. Hasil uji statistik diperoleh nilai p < 0.001 bahwa ada hubungan yang signifikan antara komplikasi intra hemodialisis dengan  kualitas hidup pada pasien yang menjalani HD. Dari hasil analisis diperoleh pula nilai OR = 0,005, artinya responden yang memiliki banyak komplikasi mempunyai peluang 0,005 kali memiliki kualitas hidup buruk dibanding responden yang memiliki sedikit komplikasi.Kesimpulan. Ada hubungan yang signifikan antara komplikasi intra hemodialisis dengan  kualitas hidup pada pasien yang menjalani hemodialisis.KataKunci: Komplikasi Intra Hemodialisis, Kualitas Hidup, Hemodialisis ABSTRACTBackground: Hemodialysis is safe and beneficial to the patient. However, there are various complications may occur when the patients undergo hemodialysis. These complications can lead to the emergence of new problems which are more complex and affect to the quality of life and even cause death.Aim: To determine the relationship of intra hemodialysis complications with quality of life in patients with Chronic Stage Kidney Disease (CKD) Stage V who undergo hemodialysis.Method:This study employed correlational analytic design with cross-sectional approach. To conduct this study, there were 166 respondents recruited as the sample by using probability sampling with total sampling technique. The data were collected by using questionnaire and observation sheet. Further, the data were analyzed by non-parametric test (Chi Square).Finding: The findings indicated that the average number of intra hemodialysis complications is less than two complications (few complications). There were found that 52.3% patients who had complication of hypertension intra hemodialysis. On the other hand, there was 0%of the respondents experienced seizures and decreased awareness complications during the study. The quality of life of CKD stage V patients underwenthemodialysis at BRSU Tabanan is categorized as good quality. The statistical test obtained p <0.001, it meant that there was a significant relationship between intra hemodialysis complications with quality of life in patients underwenthemodialysis. It also found that the analysis results of OR = 0.005, it meant that respondents who had many complications have a chance of 0.005 times experienced poor quality of life rather than the patients who had few complications.Conclusion: There is a significant relationship between intra hemodialysis complications and quality of life in patients undergo hemodialysis. Keywords: Complications of Intra Hemodialysis, Quality of Life, Hemodialysis

The impact of axial spondyloarthritis on quality of life (QoL): a comparison with the impact of moderate to end-stage chronic kidney disease on QoL

2018 ◽  
Vol 27 (9) ◽  
pp. 2321-2327 ◽  
Author(s):  
Yu Heng Kwan ◽  
Warren Fong ◽  
Priscilla How ◽  
Hwee-Lin Wee ◽  
Ying Ying Leung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Axial Spondyloarthritis ◽  
End Stage ◽  
The Impact

Abstract 321: Impact Of Chronic Kidney Disease On Heart Failure Outcomes In A Minority Cohort

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
TAOPHEEQ MUSTAPHA ◽  
VARIJA BHOGIREDDY ◽  
HARTMAN MADU ◽  
ADU BOACHIE ◽  
ABDUL OSENI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
African American ◽  
Kidney Disease ◽  
Prognostic Impact ◽  
Mortality And Morbidity ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

BACKGROUND: Heart failure (HF) and Chronic kidney disease (CKD) are major public health problems that often co-exist with a resultant high mortality and morbidity. Most of the studies evaluating their reciprocal prognostic impact have focused on mortality in majority populations. There is limited literature on the impact of CKD on HF morbidities in ethnic minorities. AIMS: Our study seeks to compare HF outcomes in patients with or without CKD in an African-American predominant cohort. METHODS: We obtained data from the NGH at Meharry Heart Failure Cohort; a comprehensive retrospective HF database comprised of patient care data (HF admissions, non-HF admissions, and emergency room visits) were assessed from January 2006 to December 2008. The study group consist of 306 subjects with a mean age of 65±15 years. 81% were African-American (AA), 19% Caucasian and 48.5% are females. Following the NKF KDOQI guidelines, 5 stages of CKD were outlined based on GFR. RESULTS: The overall prevalence of CKD in this population is 54.2%. CKD stage 1 was most prevalent with 45.8%, prevalence for stages 2-5 are 21.6%, 18.3%, 9.5% and 4.9% respectively. The comparison of the mean of ER visits, non HF hospitalizations and HF hospitalizations between normal and CKD patients was done using independent t-test and showed no significant difference in the mean number of ER visits (p=0.564), or HF hospitalizations(p=0.235). However, there is a statistically significant difference in the mean number of non -HF hospitalizations between normal and CKD patients (p=0.031). CONCLUSION: This study shows that the prevalence of CKD in this minority -predominant HF cohort is similar to prior studies in majority populations. However, only the non-HF hospitalizations were significantly increased in the CKD group. Future prospective studies will be needed to define the implications of this in the management of HF patients with CKD.

Analysing the impact of a guideline for the use of new potassium binders for treatment of chronic hyperkalaemia to maximise inhibition of renin–angiotensin–aldosterone system (RAAS) within the general nephrology clinic?

2020 ◽  
Author(s):  
Priyank Patel ◽  
Andrew Frankel
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Ckd Stage ◽  
The Mean ◽  
Potassium Binders ◽  
The Impact ◽  
Chronic Use

Abstract Background Renin–angiotensin–aldosterone system (RAAS) inhibitors provide significant cardiorenal benefits with improved long-term outcomes for patients. This is most significant for patients receiving maximal RAAS inhibition, but some patients are unable to tolerate this therapy because of hyperkalaemia. Recently published National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommended using sodium zirconium cyclosilicate (SZC) and patiromer for patients with chronic kidney disease (CKD) stage 3b to 5 or heart failure with reduced ejection fraction, who are not taking an optimised dosage of RAAS inhibitor because of hyperkalaemia. Objective Determine the impact of a locally produced guideline on effective implementation of NICE recommendation for use of SZC or patiromer to help maximise inhibition of the renin–angiotensin–aldosterone system within the general nephrology clinic. Methods A local guideline to practically support the implementation of recommendations made by NICE in the chronic use of new potassium binders was produced. One hundred sequential patients in a general nephrology clinic with non-immune chronic kidney disease (CKD 3 to 5) had their electronic records reviewed. Those with an indication for RAAS inhibition were identified. Results Of the 100 consecutive patients audited, 46 were female and 54 were male. The mean age of these patients was 64 and the mean estimated glomerular filtration rate (eGFR) was 33. Sixty-eight patients had an indication for being on RAAS inhibition with only 10 on maximal doses. Of the remaining 58 patients, 26 (45%) were limited by hyperkalaemia. Of these 26 patients, 12 of these patients (46%) had hyperkalaemia associated with an episode of acute kidney injury (AKI). Therefore, 14% of patients attending a general nephrology clinic were identified suitable for SZC and patiromer. Conclusions A significant proportion (14%) of unselected patients attending a general nephrology clinic were not on optimum RAAS inhibition due to hyperkalaemia. These patients would meet the criteria established within a working guideline for the implementation of the chronic use of SZC or patiromer and are likely to attain prognostic long-term benefit by using these new potassium binders to maximise RAAS inhibition. This analysis has implications for renal centres across the UK.

scholarly journals Patterns of medication use and the burden of polypharmacy in patients with chronic kidney disease: the German Chronic Kidney Disease study

2019 ◽  
Vol 12 (5) ◽  
pp. 663-672 ◽  
Author(s):  
Insa M Schmidt ◽  
Silvia Hübner ◽  
Jennifer Nadal ◽  
Stephanie Titze ◽  
Matthias Schmid ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Medication Use ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Median Number ◽  
Converting Enzyme Inhibitors ◽  
Ckd Stage ◽  
Multiple Drugs

Abstract Background Patients with chronic kidney disease (CKD) bear a substantial burden of comorbidities leading to the prescription of multiple drugs and a risk of polypharmacy. However, data on medication use in this population are scarce. Methods A total of 5217 adults with an estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73 m2 or an eGFR ≥60 mL/min/1.73m2 and overt proteinuria (>500 mg/day) were studied. Self-reported data on current medication use were assessed at baseline (2010–12) and after 4 years of follow-up (FU). Prevalence and risk factors associated with polypharmacy (defined as the regular use of five or more drugs per day) as well as initiation or termination of polypharmacy were evaluated using multivariable logistic regression. Results The prevalence of polypharmacy at baseline and FU was almost 80%, ranging from 62% in patients with CKD Stage G1 to 86% in those with CKD Stage G3b. The median number of different medications taken per day was eight (range 0–27). β-blockers, angiotensin-converting enzyme inhibitors and statins were most frequently used. Increasing CKD G stage, age and body mass index, diabetes mellitus, cardiovascular disease and a history of smoking were significantly associated with both the prevalence of polypharmacy and its maintenance during FU. Diabetes mellitus was also significantly associated with the initiation of polypharmacy [odds ratio (OR) 2.46, (95% confidence interval 1.36–4.45); P = 0.003]. Conclusion Medication burden in CKD patients is high. Further research appears warranted to address the implications of polypharmacy, risks of drug interactions and strategies for risk reduction in this vulnerable patient population.

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