Role of a clinical pharmacist in managing diabetic nephropathy: an approach of pharmaceutical care plan

AIM To evaluate the effect of low-protein diet on renal function in patient with diabetic nephropathy. MATERIALS AND METHODS This is a case of a 57-year-old obese patient who is a known case of type 2 diabetes, hypertension, benign prostate hypertrophy and chronic kidney disease 4(th) stage presented with the complaints of weakness, dyspnea, arthralgia, neuropathic pains and pedal edema which are prominent symptoms of Chronic kidney disease. Our healthcare team had visited patient's home and analyzed the available reports on kidney profile, fasting sugar, post prandial sugar, HbA1c, lipid profile test and prescriptions which was found to be high. The glomerular filtration rate, serum creatinine and blood urea were 24 ml/min, 3.4 mg/dL and 90 mg/dL, fasting blood sugar, post prandial blood sugar and HbA1c were 226, 305 and 7.4 %, and total cholesterol and triglycerides were 145 & 95 respectively. Further discussion on diet, it came to know that the patient was on high carbohydrate diet. By considering the objective and subjective data, our team had done the assessment and come to a conclusion that high amount of carbohydrate diet with poor medication adherence had led to the hyperglycemia which developed diabetic nephropathy. We have recommended low protein, unsaturated fat, multivitamins, antioxidants and moderate carbohydrate diet. Two dietary assessment tools had been used in order to monitor patient's adherence to the diet i.e. dietary record book and food frequency questionnaire. RESULTS We have carefully monitored the serum creatinine, glomerular filtration rate and blood urea for 12 months initially with an interval of 30 days for 3 months and later trimonthly up-to 12 months. Glomerular filtration rate was calculated by using the formula CKD-EPI creatinine equation. The values trend for first three months of serum creatinine and glomerular filtration rate were 2.8 mg/dL, 2.6 mg/dL,1.5 mg/dL and 24 ml/min, 26 ml/min, 51 ml/min respectively. Further, results has shown a significant improvement in the 6th, 9th and 12th month. The values of serum creatinine in the 6th, 9th and 12th month were 1.3 mg/dL, 1.1 mg/dL and 0.9 mg/dL, whereas golmerular filtration rate in the 6th, 9th and 12th month were 61 ml/min, 74 ml/min and 94 ml/min. CONCLUSION The present study has demonstrated the protein diet restriction in-order to control the progression of renal failure. The dietary intervention on diabetic nephropathy plays a significant role in controlling the kidney failures. This is the first study, to our knowledge, to demonstrate the impact of pharmacist role in managing diabetic nephropathy by providing pharmaceutical care. Pharmaceutical care services should be encouraged in the community and hospital pharmacy which definitely plays a major impact in reaching the definite outcomes and providing higher quality of life.