Papastergiou John, Donnelly Michelle, Li Wilson, Sindelar Robert D, van den Bemt Bart
Shoppers Drug Mart, Toronto, ON, Canada.
University of Toronto, ON, Canada.
Can J Kidney Health Dis. 2020 May 18;7:2054358120922617. doi: 10.1177/2054358120922617. eCollection 2020.
Chronic kidney disease (CKD) is a condition presenting with long-term slow progression of structural and/or functional damage to the kidneys. Early detection is key to preventing complications and improving outcomes. Point-of-care estimated glomerular filtration rate (eGFR) screening technology allows for detection of abnormal kidney function in the community pharmacy setting.
To evaluate the effectiveness of a community pharmacist-directed point-of-care screening program and to identify the prevalence of CKD in high-risk patients.
Quantitative observational.
Four community pharmacies in British Columbia over a 6-month period.
In all, 642 participants with at least one CKD risk factor were identified and screened. Mean age was 60 years and females accounted for 55% of the study population.
Serum creatinine was measured from peripheral blood using the HeathTab® screening system (Piccolo® Renal Function Panel with the Piccolo® blood chemistry analyzer). eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.
Patients provided a sample of peripheral blood via a self-administered finger-prick and analytical data to assess kidney function was reported including blood urea nitrogen (BUN), serum creatinine, and electrolytes by the HealthTab screening system. Once results were available, the pharmacist conducted a comprehensive medication review with the patient and recommended certain follow-up actions if appropriate.
CKD risk factor included diabetes (30%), hypertension (45%), cardiovascular disease (12%), family history of kidney disease (13%), age over 55 years (68%), and an Aboriginal, Asian, South Asian, or African ethnic background (82%). A total of 11.5% of patients had eGFR values lower than 60 mL/min (abnormal renal function) and 34% had an eGFR between 60 and 89 mL/min (minimally reduced renal function). Overall pharmacists' actions included blood pressure check (98%), education on CKD and risk factors (89%), medication review (72%), and physician follow-up (38%). Limitations included lack of follow-up beyond the 3-month study period prevented medical confirmation of CKD and limited the ability to quantify the impact of pharmacist interventions on the clinical outcomes of patients with low eGFR.
These results illustrate the prevalence of abnormal renal function among undiagnosed, high-risk patients in the community. Pharmacists, as the most accessible healthcare practitioners, are ideally positioned to utilize novel point-of care technologies to improve access to CKD screening, facilitate follow-up, and increase awareness around the importance of early detection.
慢性肾脏病（CKD）是一种以肾脏结构和/或功能长期缓慢损害为特征的疾病。早期检测是预防并发症和改善预后的关键。即时检验估算肾小球滤过率（eGFR）筛查技术可在社区药房环境中检测肾功能异常。
评估由社区药剂师指导的即时检验筛查项目的有效性，并确定高危患者中CKD的患病率。
定量观察性研究。
不列颠哥伦比亚省的四家社区药房，为期6个月。
共识别并筛查了642名至少有一项CKD危险因素的参与者。平均年龄为60岁，女性占研究人群的55%。
使用HeathTab®筛查系统（配备Piccolo®血液化学分析仪的Piccolo®肾功能检测板）从外周血中测量血清肌酐。根据慢性肾脏病流行病学协作组（CKD-EPI）公式计算eGFR。
患者通过自行手指采血提供外周血样本，HeathTab筛查系统报告评估肾功能的分析数据，包括血尿素氮（BUN）、血清肌酐和电解质。结果出来后，药剂师与患者进行全面的用药审查，并在适当情况下建议采取某些后续行动。
CKD危险因素包括糖尿病（30%）、高血压（45%）、心血管疾病（12%）、肾病家族史（13%）、年龄超过55岁（68%）以及原住民、亚洲、南亚或非洲族裔背景（82%）。共有11.5%的患者eGFR值低于60 mL/分钟（肾功能异常），34%的患者eGFR在60至89 mL/分钟之间（肾功能轻度降低）。药剂师的总体行动包括血压检查（98%）、CKD及危险因素教育（89%）、用药审查（72%）和医生随访（38%）。局限性包括在3个月的研究期之后缺乏随访，无法对CKD进行医学确认，并且限制了量化药剂师干预对低eGFR患者临床结局影响的能力。
这些结果说明了社区中未确诊的高危患者肾功能异常的患病率。药剂师作为最易接触到的医疗从业者，处于理想位置，可以利用新型即时检验技术来改善CKD筛查的可及性、促进随访并提高对早期检测重要性的认识。
