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: 2.07). 09/2009; 23(1):55-61. DOI: 10.1111/j.1525-139X.2009.00629.x
Source: PubMed

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The novel iron-based phosphate binder sucroferric oxyhydroxide is being investigated for the treatment of hyperphosphatemia. Patients with chronic kidney disease often have multiple comorbidities that may necessitate the daily use of several types of medication. Therefore, the potential pharmacokinetic drug-drug interactions between sucroferric oxyhydroxide and selected drugs commonly taken by dialysis patients were investigated. Five Phase I, single-center, open-label, randomized, three-period crossover studies in healthy volunteers investigated the effect of a single dose of sucroferric oxyhydroxide 1 g (based on iron content) on the pharmacokinetics of losartan 100 mg, furosemide 40 mg, omeprazole 40 mg, digoxin 0.5 mg and warfarin 10 mg. Pharmacokinetic parameters [including area under the plasma concentration-time curve (AUC) from time 0 extrapolated to infinite time (AUC0-∞) and from 0 to 24 h (AUC0-24)] for these drugs were determined: alone in the presence of food; with sucroferric oxyhydroxide in the presence of food; 2 h after food and sucroferric oxyhydroxide administration. Systemic exposure based on AUC0-∞ for all drugs, and AUC0-24 for all drugs except omeprazole (for which AUC 0-8 h was measured), was unaffected to a clinically significant extent by the presence of sucroferric oxyhydroxide, irrespective of whether sucroferric oxyhydroxide was administered with the drug or 2 h earlier. There is a low risk of drug-drug interactions between sucroferric oxyhydroxide and losartan, furosemide, digoxin and warfarin. There is also a low risk of drug-drug interaction with omeprazole (based on AUC0-∞ values). Therefore, sucroferric oxyhydroxide may be administered concomitantly without the need to adjust the dosage regimens of these drugs.
    Journal of nephrology 04/2014; 27(6). DOI:10.1007/s40620-014-0080-1 · 2.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To explore attitudes towards medicines, polypharmacy and adherence in patients with chronic kidney disease (CKD). Polypharmacy is common in CKD and associated with medication non-adherence. As part of a mixed methodology project, a purposive sample of ten participants were recruited and interviewed to explore attitudes to medicines and reasons for adherent and non-adherent behaviour. Several reasons for non-adherence were reported. Interviewees described a variety of attitudes towards medicines. Complex medicine regimes were a frequently cited contributing factor in poor adherence. Concerns about or experience of side effects had a negative impact on adherence. Prioritisation of medicines was evident and the importance of communication with health professionals was a consistent theme. Non-adherence with prescribed medicines in CKD is a complex phenomenon, which has implications for clinical outcomes and cost. Adherent behaviour may change over time. Further research in this field is needed. No single intervention is likely to enhance adherence for all and clinicians should consider a variety of options to improve adherence with prescribed medicines.
    Journal of Renal Care 12/2013; 39(4):200-207. DOI:10.1111/j.1755-6686.2013.12037.x
  • [Show abstract] [Hide abstract]
    ABSTRACT: AIM: The aim of this study is to evaluate the breadth and depth of the allied health workforce providing renal services in Queensland, Australia. METHODS: Workforce statistics were reported for allied health renal services (excluding transplant) across all 14 publically funded regions across Queensland, Australia. Dietetics, pharmacy, podiatry, psychology and social work were compared with workforce benchmarks capturing full-time equivalent (FTE) to dialysis patient numbers (1 FTE:diaysis patients). RESULTS: Wide variation was evident within and between professions. All services provided dietetics, with nine services meeting the benchmark, with an average (median) of 1:127 (range 1:36-1:207). Ten services provided pharmacy (1:245 [1:36-1:845]), twelve provided social work (1:191 [1:71-1:845]) and seven provided psychology services (1:396 [1:155-1:1690]). Only one-third of units funded podiatry services (1:1077 [1:143-1:4300]), none of which met benchmark. CONCLUSION: There is a clear disparity in allied health workforce across in this region, with the vast majority below benchmark recommendations. In light of increasing demand for this area, it is timely to identify strategies for innovative workforce design to manage growth in allied health service needs into the future.
    Journal of Renal Care 01/2013; DOI:10.1111/j.1755-6686.2012.00330.x


Available from