Department of Pharmacology and Toxicology, University of Vienna, Althanstraße 14, 1090 Vienna, Austria.
BMC Nephrol. 2011 Jul 22;12:35. doi: 10.1186/1471-2369-12-35.
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations.
A literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems.
Among a total of 21 studies, only four (19%) were controlled trials. The majority of studies were descriptive (67%) and before-after studies (14%). Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials) presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional pharmacotherapy, and medical record discrepancies.
Few high-quality trials addressing the benefit and impact of clinical pharmacy services in CKD and ESRD patients have been published. However, all available studies reported some positive impact resulting from clinical pharmacist involvement, including various investigated outcome measures that could be improved. Additional randomised controlled trials investigating patient-oriented outcomes are needed to further determine the role of clinical pharmacists and the benefits of clinical pharmacy services to CKD and ESRD patients.
慢性肾脏病（CKD）和终末期肾病（ESRD）是全球性的健康问题，其流行程度已经到了令人担忧的地步。因此，必须重视优化患者的治疗，因为已有充分的证据表明 CKD 和 ESRD 患者的治疗存在差距。作为多学科患者治疗策略的一部分，临床药学服务已经改善了患者的治疗效果。本研究旨在总结关于临床药师为这些患者群体提供服务的作用和影响的现有证据。
使用 Medline、Embase 和国际药学文摘数据库进行文献检索，以确定关于临床药师对 CKD 和 ESRD 患者的影响的研究，这些研究涉及疾病导向和患者导向的结局，以及临床药师干预药物相关问题。
在总共 21 项研究中，只有 4 项（19%）为对照试验。大多数研究为描述性研究（67%）和前后对照研究（14%）。干预措施包括以检测、解决和预防药物相关问题为重点的一般临床药学服务、以疾病管理为重点的临床药学服务，或以提高药物知识为重点的患者教育的临床药学服务。贫血是临床药师最常管理的合并症，他们的参与显著改善了所研究的疾病导向结局，例如血红蛋白水平。只有 4 项研究（包括 3 项对照试验）提供了患者导向结局的数据，例如生活质量和住院时间。研究临床药师干预的数量和类型以及医生接受率的研究报告的平均接受率为 79%。最常见的报告药物相关问题是剂量不正确、需要额外的药物治疗和医疗记录差异。
发表的关于 CKD 和 ESRD 患者临床药学服务的益处和影响的高质量试验很少。然而，所有现有研究都报告了临床药师参与带来的一些积极影响，包括可以改善的各种研究结果测量指标。需要进一步开展随机对照试验，以确定临床药师的作用以及临床药学服务对 CKD 和 ESRD 患者的益处。
