Strategies for Reducing Polypharmacy and Other Medication-Related Problems in Chronic Kidney Disease
University of Michigan College of Pharmacy, Ann Arbor, Michigan 48109-1065, USA.Seminars in Dialysis (Impact Factor: 1.75). 09/2009; 23(1):55-61. DOI: 10.1111/j.1525-139X.2009.00629.x
Medication-related problems are very common in patients with chronic kidney disease (CKD). These problems are often avoidable and can result in detrimental patient consequences and high financial costs. Despite these risks, it is often medically necessary to prescribe multiple medications to treat the comorbid conditions that accompany CKD. In addition, patients' use of nonprescription medications and changes in pharmacokinetic and pharmacodynamic parameters may further contribute to medication-related problems in CKD, including drug interactions and the need for dosage adjustments. A structured medication assessment process is one approach to reducing the risks associated with medication-related problems. This multifaceted process involves a comprehensive medication history interview, structured therapy assessment, and open communication between members of the medical team. A detailed description of this process is provided to aid healthcare providers in addressing this important issue.
Full-text previewDOI: · Available from: umich.edu
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.
Article: Medication-related Problems in CKD[Show abstract] [Hide abstract]
ABSTRACT: Patients with CKD are often prescribed heterogeneous medications to treat disease-associated comorbidities, to slow down progression of the disease, and to minimize morbidity and mortality rates. However, the medication regimens of this population are very complex, leading to an increased potential for medication-related problems (MRPs). As kidney function declines, the type and amount of medications a patient consumes increases, thereby putting them at a higher risk for MRPs. MRPs have been known to be associated with morbidity, mortality, and a lower quality of life. This review will summarize data on the prevalence and effect of MRPs, and strategies that can be used by clinicians to reduce and resolve MRPs.Advances in chronic kidney disease 09/2010; 17(5):404-12. DOI:10.1053/j.ackd.2010.06.004 · 2.05 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Inadequately controlled blood pressure is considered an important risk factor for both chronic kidney disease (CKD) progression and cardiovascular disease progression in CKD patients. Patients with CKD and hypertension are typically followed in primary care practice settings and blood pressure is not controlled in a sizeable proportion. This review will focus on the evidence which demonstrates the important role of the pharmacist in collaboration with physicians within primary care practices to improve blood pressure management in CKD patients. Several lines of evidence show that pharmacists working in collaboration with primary care physicians can improve blood pressure management as compared with usual care with a physician alone. The major effects of pharmacist intervention are to intensify antihypertensive regimens and improve medication adherence. Currently, hypertension is not well controlled in a significant proportion of individuals with CKD. Recent studies in the CKD population support evidence from the general population that pharmacists as part of the collaborative care team improves blood pressure management. Research is needed to demonstrate cost-effectiveness of collaborative care models in management of hypertension and other comorbid conditions in CKD patients.Current opinion in nephrology and hypertension 06/2011; 20(5):498-503. DOI:10.1097/MNH.0b013e32834902c8 · 3.96 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Medication-related problems are very common in patients with chronic kidney disease (CKD). Identification, prevention and management of these problems require a comprehensive, interdisciplinary approach. This article reviews the recent literature regarding medication-related problems in CKD and proposes initiatives for addressing these problems through a structured review process and use of patient-centered adherence-promoting strategies. Pharmacist-conducted medication review and intervention programs are successful at identifying and resolving medication-related problems in CKD patients. These programs are associated with a reduction in the number of medications and frequency of hospitalization, and are associated with maintenance of quality of life. However, adherence continues to be a major medication-related problem in CKD care. Structured medication review and assessment of adherence assist in identification and resolution of medication-related problems in CKD. More research is needed on successful methods to improve medication adherence and related health outcomes.Current opinion in nephrology and hypertension 09/2011; 20(5):492-7. DOI:10.1097/MNH.0b013e328349c261 · 3.96 Impact Factor