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Taking a thorough medication history, including OTC drugs, herbal supplements, drugs prescribed by non-nephrologists, and CAM drugs
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Provision of medical and therapeutic information for patients and other health care professionals
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Basic clinical assessments during patient visists
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Medication use evaluation
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Medication review at different time points, such as at admission, during inhospital treatment, during each dialysis session, and at discharge
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Training regarding the administration of drugs (e.g. ESAs self injections)
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Ordering of laboratory tests
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Audit measures
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Matching computerised medication profiles with verbally obtained medication history
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Counselling on side effects, interactions
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Co-ordering of anaemia therapies and other drugs
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Medication order review and checking adherence to prescribing guidelines
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Compiling of guidelines for proper drug use (e.g., iron and ESAs) and implementation of treatment algorithms (e.g., hyperlipidaemia, hypertension, and renoprotective drugs)
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Co-prescribing within the scope of specific guidelines (e.g., anaemia management or lipid management)
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Development of discharge medication plans
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Assessment and monitoring of compliance and adherence
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Identification of potential or actual DRPs
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Therapeutic recommendations (e.g. change of drugs, dose and/or interval adjustments, discontinuation of drugs, additional laboratory monitoring, nephrologist referral, addition of renoprotective drugs)
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Therapeutic monitoring (treatment, laboratory values, and specific drugs)
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