Standards of clinical practice for renal pharmacists.

The prevalence of chronic kidney disease (CKD) continues to increase. Patients with stage 1 to 5 CKD and those undergoing dialysis are at extremely high risk for drug therapy problems (DTPs). In controlled trials involving general patient populations, clinical pharmacist interventions have reduced hospital admissions, length of hospital stay, readmissions, and emergency department visits. The activities of pharmacists most strongly associated with improved patient outcomes include participating on rounds, interviewing patients, performing medication reconciliation, counselling patients on discharge, and conducting postdischarge followup. A systematic review of 8 controlled trials involving patients with CKD showed that clinical pharmacist interventions improved management of anemia, blood pressure, and lipids, as well as calcium and phosphate parameters. In this patient population, clinical pharmacists’ interventions reduced hospital admissions, length of hospital stay, and incidence of end-stage renal disease or death. The Manitoba Renal Program (MRP) provides comprehensive renal care throughout the province of Manitoba, Canada (population 1.2 million). The program provides care at 4 urban hospitals and 12 rural hemodialysis units. Health services offered include in-centre and home hemodialysis, peritoneal dialysis, and interprofessional renal health clinics for individuals with stage 1 to 5 CKD who do not require renal replacement therapy. At the time this article was prepared, in mid-2013, the MRP had approximately 1100 hemodialysis patients, 285 peritoneal dialysis patients, and nearly 4500 patients with stage 1 to 5 CKD.