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

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)