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Table 3 Detailed description of the included publications on dialysis patients

From: Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

First author,
(Year),
Population
Design N (INT/CT)a Duration
(months)
Interventions Relevant outcomesb Results p-Value
Tang I et al. [17], (1993), HD outpts DS NR 6 Therapeutic interventions provided by CP No./Types of interventions 205 (100%)  
Abstract         Drug selection    66 (32.2%)  
         Drug discontinuation    39 (19.0%)  
         Dose selection    50 (24.4%)  
      Significance of interventions   
         Preservation of major organ function    34.6%  
         Improvement in quality of care    62.4%  
      PhAR 91.7%  
Kaplan B et al. [18], (1994), HD outpts DS 24 NR Focused DT review programmes No. of recommendations/informative comments 114/85  
Abstract      PhAR 76% (implemented 70%)  
Grabe DW et al. [19], (1997), HD outpts DS 45 1 DT reviews by CP
Therapeutic recommendations
No./Types of DRPs 126 (100%)  
         Drug interactions    35 (27.5%)  
         Dialysis-specific DRPs    33 (26.5%)  
      PhAR 81%  
      No. of interventions 102  
         1 - adverse significance    0%  
         2 - no significance    6.9%  
         3 - somewhat significant    0%  
         4 - significant    78%  
         5 - very significant    4.9%  
         6 - extremely significant    1%  
Possidente CJ et al. [12], (1999), HD and PD inpts DS 37 3.5 CPS (MR, pts interviews, identification and resolution of DRPs) No./Types of DRPs 161  
         Pts did not receive drug   
         Overdosage   
         Labs needed   
       More DRPs (77) at admission vs. discharge (41) < 0.011
      PhAR 95.7%  
      Significance   
         Somewhat significant    24.7%  
         Significant    58.4%  
         Very significant    16.9%  
To LL et al. [26], (2001), HD outpts BAS 49 6 Pharmacist-managed programmes compared to physician-managed pts Mean HCT (± SD) during physician period vs. pharmacist period 35.36 ± 3.33/36.21 ± 3.46% 0.20
      Total EPO ? dose 8.5/7.7 million units 0.37
      Total elemental iron dose oral 85.605/95.550 mg 0.64
      Total elemental iron dose i.v. 13.600/33.025 mg < 0.001
      Mean (± SD) Tsat level 29.82 ± 14.92/30.78 ± 13.17% 0.66
Viola RA et al. [27], (2002), HD outpts DS 26 6 Pharmacist-managed hyperlipidaemia programmes with HD pts (laboratory management, counselling, statin initiation, and adjustments) % of pts achieving LDL cholesterol target at baseline vs. Month 6 58%/88% 0.015
      Mean LDL (± SD) cholesterol at baseline vs. Month 6 96c5/80 ± 3 mg/dL < 0.01
      Mean total cholesterol (± SD) at baseline vs. Month 6 170 ± 7/151 ± 4 mg/dL < 0.01
      No./Types of interventions 15  
         Dose increase    6  
         Drug change    5  
         Therapy initiation    2  
Kimura T et al. [28], (2004), HD outpts DS 41 9 Pharmacist-managed anaemia programmes No. pts achieving the HCT target of >30% at baseline vs. Month 9 7 (17.1%)/32 (78%)  
      No. pts with EPO dose reductions due to intervention 23 (56%)  
Manley HJ et al. [29], (2004), HD outpts
Abstract
DS 408 NR Implementations of treatment algorithms for CV disease in HD pts by a pharmacist, collections of CV medication-related issues and recommendations to nephrologists, pts interview, MR No. of recommendations 1575  
      PhAR 79.8%  
      Impact of recommendations on pts care   
         Improvement    89.9%  
         No impact    7.6%  
         Worsened pts care    2.4%  
      LDL cholesterol -31.2 mg/dL < 0.001
      HbA1C -0.3% NS
      Adjusted CV mortality hazard ratio 0.48 (CI 0.18, 1.3)  
Walton T et al. [30], (2005), HD outpts DS 278 26 Pharmacist-managed anaemia programmes Hb value at baseline and Month 6 9.5/11.8 g/dL  
      Mean (± SD) ferritin at baseline and Month 6 280.9 ± 326.4/431 ± 232.1 ng/mL  
      Mean (± SD) Tsat at baseline and Month 6 21 ± 7.9/33 ± 8%  
Sathvik BS et al. [32], (2007), HD outpts RCT 90 4 Pharmacist-provided pts education Medication knowledge (MKAQ) at baseline, Month 2 and 4 in Group 1 and 2 Improvement in MKAQ scores in Group 1 compared to baseline and to Group 2 at Month 2 < 0.05
     Group 1: Pharmacist pts education (Month 0-2)   No significant improvement in MKAQ scores in Group 2 compared to baseline at Month 2 >0.05
     Group 2: Usual health care w/o pharmacists (Month 0-2)   Improvement in MKAQ scores in Group 2 at Month 4 compared to baseline and to scores at Month 2 < 0.05
     Switch at Month 2   Decrease in MKAQ scores in Group I at Month 4 compared to Month 2 < 0.05
Erickson AI et al. [20], (2008), HD in- and outpts DS 1184 pts visits 4 Prospective order review by CP and general CPS Compliance with prospective order review 1059 (89.4%)  
      No./Types of interventions 77 (100%)  
         Therapeutic-related    11 (14.3%)  
         Safety-related    49 (63.6%)  
         Compliance-related    17 (22.1%)  
      PhAR 100%  
Castro R et al. [13], (2009), HD in- and outpts BAS 60 6 MTM Disease control parameters at baseline vs. follow-up visit at Day 90   
   Abstract      SBP (MTM) 150 ± 22/144 ± 18 mmHg 0.12
      SBP (non-MTM) 143 ± 21/145 ± 25 mmHg NS
      HbA1c (MTM) 9.2 ± 1.6/9.0 ± 2.0% 0.58
      HbA1c (non-MTM) 6.2 ± 1.2/6.5 ± 1.4% NS
      Phosphorus (MTM) 6.2/5.6 mg/dL .096
      Calcium/phosphorous product (MTM) 56 ± 19/50 ± 16 .03
Mirkov S [21],
(2009), HD outpts
DS 64 8 DT reviews by CP No./types of DRPs 278 (100%)  
         Non-adherence    61 (22%)  
         Overdosage    26 (9.3%)  
         Untreated indication    24 (8.6%)  
Pai AB et al. [22], (2009), HD outpts RCT 104 (57/47) 24 INT: PC, DT reviews by CP No./Types of DRPs 530 (100%)  
     CT: SOC, DT reviews by dialysis nurse    Drug record discrepancy    133 (25%)  
         Untreated indication    111 (21%)  
         Subtherapeutic dosage    74 (14%)  
      PhAR 100%  
      Reduction in drug use in INT 14% < 0.05
      Reduction of hospitalisations in INT 42% 0.02
      Reduction of LOS in INT 21% 0.06
Pai AB et al. [23], (2009), HD outpts RCT 107 (61/46) 24 INT: PC, DT reviews by CP Total RQLP scores at Year 1 compared to baseline INT/CT Worsening in Total RQLP score at Year 1 in CT group (88 ± 31/71 ± 34) 0.03
     CT: SOC, DT reviews by dialysis nurse Total RQLP scores at Year 2 compared to baseline INT/CT Improvement in INT/CT group, no statistically significant difference  
  1. BAS before-after study, CP clinical pharmacist, CPS clinical pharmacy services, CV cardiovascular diseases, DRP drug-related problem, DS descriptive study, DT drug therapy, EPO erythropoietin, HbA 1c glycosylated haemoglobin, HCT haematocrit, HD haemodialysis, Hb haemoglobin, LDL low-density lipoprotein, LOS length of stay, MKAQ medication knowledge assessment questionnaire, MR medication review, MTM medication therapy management service, No. number, NR not reported, NS not significant, PC pharmaceutical care, PhAR physician acceptance rate, pts patients, RCT randomised controlled trial, RQLP renal quality of life profile, SBP systolic blood pressure, SD standard deviation, SOC standard of care
  2. a Number of included patients in the intervention (INT) or control (CT) group
  3. b For brevity, only the three most commonly performed interventions/drug-related problems are listed.