Abstract��
OBJECTIVE To evaluate the effect of pharmacists�� interventions in the management of chronic kidney disease. METHODS CENTRAL, MEDLINE OVID SP, EMBASE OVID SP, CNKI and Wanfang Data were searched for studies regarding pharmacists�� interventions in CKD patients. Methodological quality of RCTs included was assessed using the Cochrane Collaboration��s tool for assessing risk of bias. RESULTS Twenty-seven studies were included. Among them there were 13 RCTs, 8 quasi-randomized controlled trials, 5 cohort studies and 1 economic study. Only 1 of the included RCTs presented a low risk of bias, while the rest were all with unknown risk. The RESULTS showed that pharmacists�� interventions significantly reduced the rates of ESRD and all-cause death, decreased the number of transplant rejections and adverse reactions, while improving the standard rate of drug concentrations. Pharmacists�� interventions made patients�� serum creatinine, blood pressure, lipids, glucose and phosphate level under control, at the same time they played a positive role in the management of secondary hyperparathyroidism and anemia. In addition, pharmacists�� interventions significantly improved patients�� quality of life, as well as their medication compliance and knowledge. They also saved much money for institutions and patients. CONCLUSION Pharmacists�� participation seems to have a positive impact on the control of diseases, the enhancement of life quality, the improvement of medication compliance and knowledge, and the alleviation of financial burden. However, high-quality clinical evidence is still needed to assess the degree of this impact.
CHEN Chao-Yang,
SHENG Xiao-Yan,
LIANG Yan etc
.Pharmacists�� Participation in the Management of Chronic Kidney Disease: A Systematic Review[J] Chinese Pharmaceutical Journal, 2015,V50(1): 80-84
��
[1]
TANG S,GONG Z F. Research progress of epidemiological survey of chronic kidney disease . Chin J New Clin Med(�й��ٴ���ҽѧ), 2011, 4(5): 478-481.[2] RONKSLEY P E, HEMMELGARN B R. Optimizing care for patients with CKD . Am J Kidney Dis, 2012, 60(1): 133-138.[3] JIANG S P, ZHU Z Y, XIAO Y H, et al. Retrospective analysis of clinical pharmacists�� interventions in antibiotics dosage adjustment of continuous renal replacement therapy patients . Chin Pharm J (�й�ҩѧ��־), 2013, 48(10): 827-830.[4] CHEN Y R, YANG Y, WANG S C, et al. Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: A 3-year prospective cohort study . Nephrol Dial Transplant, 2013, 28(3): 671-682.[5] Kidney Disease: Improving Global Outcomes(KDIGO) CKD Work Group. KDIGO 2012 Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int, 2013, 3:1.[6] LIU M. The Design and Implementation Methods of Systematic Reviews and Meta-Analysis(ϵͳ���ۡ�Meta-���������ʵʩ����) . Beijing: People��s Health Press, 2011: 1-200.[7] CHISHOLM M A, VOLLENWEIDER L J, REINHARDT B O, et al. Effect of pharmaceutical care services on the blood pressure of renal transplant patients . Pharmacotherapy, 1999, 19(10): 1229-1230.[8] CHISHOLM M A, REINHARDT B O, VOLLENWEIDER L, et al. Renal transplant clinic patients�� satisfaction with health care quality: Effect of pharmaceutical care services . Pharmacotherapy, 1999, 19(10): 1237.[9] CHISHOLM M A, VOLLENWEIDER L J, MULLOY L L, et al. Pharmaceutical care services reduce adverse drug reactions in renal transplant patients . Pharmacotherapy, 2000, 20(10): 1280. CHISHOLM M A, MULLOY L L, JAGADEESAN M, et al. Impact of clinical pharmacy services on renal transplant patients�� compliance with immunosuppressive medications. Clin Transplant, 2001, 15(5): 330-336. CHISHOLM M A, MULLOY L, JAGADEESAN M, et al. Two-year economic evaluation of clinical pharmacy services in renal transplant clinic patients. Am J Transplant, 2002, 2(suppl 3): 286. CHISHOLM M A, MULLOY L L, JAGADEESAN M, et al. Effect of clinical pharmacy services on the blood pressure of African-American renal transplant patients . Ethn Dis, 2002, 12(3): 392-397. LALIBERTE M C, NORMANDEAU M, LORD A, et al. Potential misuse of over-the-counter medications and natural products in patients with moderate and severe chronic renal insufficiency. Can J Clin Pharmacol, 2006, 13(1): e137. SATHVIK B S, MANGASULI S, NARAHARI M G, et al. Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge . Indian J Pharm Sci, 2007, 69(2): 232-239. LALIBERTE M C, NORMANDEAU M, LORD A, et al. Use of over-the-counter medications and natural products in patients with moderate and severe chronic renal insufficiency . Am J Kidney Dis, 2007, 49(2): 245-256. YOKUM D, GLASS G, CHEUNG C F, et al. Evaluation of a phosphate management protocol to achieve optimum serum phosphate levels in haemodialysis patients . J Ren Nutr, 2008, 18(6): 521-529. PAI A B, BOYD A, CHAVEZ A, et al. Health-related quality of life is maintained in hemodialysis patients receiving pharmaceutical care: A 2-year randomized, controlled study . Hemodial Int, 2009, 13(1): 72-79. PAI A B, BOYD A, DEPCZYNSKI J, et al. Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: A 2-year, randomized, controlled study . Pharmacotherapy, 2009, 29(12): 1433-1440. ZHANG F K, KANG Z R, SHI R W, et al. Efficacy observation on antihypertensive effect of pharmaceutical care on patients with end- stage renal disease hemodialysis combining with high blood pressure . J China Pharm (�й�ҩ��), 2010, 21(26): 2493-2494. ANONYMOUS. Pharmacist-run program optimally manages secondary hyperparathyroidism . Formulary, 1998, 33(12): 1217-1218. CHISHOLM M A, VOLLENWEIDER L J, MULLOY L L, et al. Cost-benefit analysis of a clinical pharmacist-managed medication assistance program in a renal transplant clinic . Clin Transplant, 2000, 14(4): 304-307. VIOLA R A, ABBOTT K C, WELCH P G, et al. A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients . BMC Nephrol, 2002, 3(1): 9. MANLEY H J, DRAYER D K, MUTHER R S. Medication-related problem type and appearance rate in ambulatory hemodialysis patients . BMC Nephrol, 2003, 4(1): 10. WALTON T, HOLLOWAY K P, KNAUSS M D. Pharmacist-managed anemia program in an outpatient hemodialysis population . Hosp Pharm, 2005, 40(12): 1051-1056. LEUNG W Y, SO W Y, TONG P C. Effects of structured care by a pharmacist-diabetes specialist team in patients with type 2 diabetic nephropathy . Am J Med, 2005, 118(12): 1414. CHISHOLM M A, SPIVEY C A, MULLOY L L. Effects of a medication assistance program with medication therapy management on the health of renal transplant recipients. Am J Health Sys Pharm, 2007, 64(14): 1506-1512. ALLENET B, CHEN C, ROMANET T, et al. Assessing a pharmacist-run anaemia educational programme for patients with chronic renal insufficiency . Pharm World Sci, 2007, 29(1): 7-11. WANG H Y, CHAN A L, CHEN M T, et al. Effects of pharmaceutical care intervention by clinical pharmacists in renal transplant clinics . Transplant Proc, 2008, 40(7): 2319-2323. ARROYO L �r, GRANA E C, ROS N B, et al. Assessment of a pharmaceutical interventional programme in patients on medications with renal risk . Farm Hosp, 2009, 33(3): 147-154. HASSAN Y, AL-RAMAHI R J, AZIZ N A, et al. Adverse drug events in hospitalized patients with chronic kidney disease . Int J Clin Pharmacol Ther, 2010, 48(9): 571-576. ABRAHAM S, RAMACHANDRAN A. Estimation of quality of life in haemodialysis patients . Indian J Pharm Sci, 2012, 74(6): 583-587. HLUBOCKY J M, STUCKEY L J, SCHUMAN A D, et al. Evaluation of a transplantation specialty pharmacy program . Am J Health Syst Pharm, 2012, 69(4): 340-347. BELAICHE S, ROMANET T, ALLENET B, et al. Identification of drug-related problems in ambulatory chronic kidney disease patients: A 6-month prospective study. J Nephrol, 2012, 25(5): 782-788. SALGADO T M, MOLES R, BENRIMOJ S I, et al. Pharmacists�� interventions in the management of patients with chronic kidney disease: A systematic review. Nephrol Dial Transplant, 2012, 27(1): 276-292.
2015, Vol. 50 