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Table 4 Comprehensive listing of clinical pharmacy activities performed in CKD and ESRD patients

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

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