Practice spotlight: pharmacist in a chronic kidney disease clinic.

T he Chronic Kidney Disease Program is a multidisciplinary outpatient clinic and outreach program at St Paul's Hospital in Saskatoon, Saskatchewan. The clinic opened in July 2001 with a vision to care for, educate, and support individuals and their families along the continuum of chronic kidney disease to achieve optimal outcomes. The clinic serves the northern half of the province and as of September 2010 had about 550 patients. The program's health care team has grown substantially since 2001 and now consists of nephrologists, registered nurses, an Aboriginal health educator, a dialysis access nurse, a dietician, a diabetes clinician, a social worker, an exercise therapist, a pharmacist, and support staff. The clinical pharmacist position (1 full-time equivalent [FTE]) was created in mid-2008, at the request of the hospital's department of Renal Services, and Angela McKinnon has held the position since then. Renal Services has an additional 4.3 FTE pharmacist positions in other areas (Hemodialysis, Home Therapies, and Transplant). The Chronic Kidney Disease Clinic has a diverse patient population, and the clinic team faces many challenges in providing patient care, including linguistic and cultural barriers and financial and travel issues. Most patients have stage 3 to 5 chronic kidney disease (creatinine clearance less than 60 mL/min) due to a variety of causes. The patients range in age from 18 to over 90 years, and more than half (52%) have diabetes mellitus. The team works with patients to slow the progression of their disease and to manage the associated symptoms, educating them about treatment options as the disease progresses. The clinic pharmacist provides a number of services to both patients and other members of the team. Each patient is referred to the Chronic Kidney Disease Clinic by his or her nephrologist. At the initial appointment, the patient meets with all team members for a needs assessment. The pharmacist obtains the patient's medication and allergy histories. The pharmacist also educates the patient about the importance of medication management in chronic kidney disease, adherence to drug regimens, and the potential risks of nephrotoxic medications. At subsequent visits, the patient is seen by specific team members, as appropriate to the person's laboratory results or as requested by the patient or other team members. The pharmacist continually assesses drug therapy for efficacy and adverse effects, using laboratory results, the results of physical examinations performed during clinic visits, and information obtained during phone conversations with the patient. …