Ardavani Ashkon, Curtis Ffion, Hopwood Ellen, Highton Patrick, Katapa Priscilla, Khunti Kamlesh, Wilkinson Thomas J
NIHR Applied Research Collaboration East Midlands (ARC-EM), Leicester Diabetes Centre, University of Leicester, Leicester, UK.
Liverpool Reviews and Implementation Group (LRIG), Institute of Population Health, University of Liverpool, Liverpool, UK.
Nephrol Dial Transplant. 2025 Apr 28;40(5):884-907. doi: 10.1093/ndt/gfae221.
Pharmacists are uniquely placed with their therapeutic knowledge to manage people with chronic kidney disease (CKD). Data are limited regarding the impact of pharmacist interventions on economic, clinical and humanistic outcomes (ECHO).
A systematic review and meta-analysis of randomized controlled trials (RCTs) of interventions with pharmacist input was conducted, which included adults with a diagnosis of CKD, including those with and without kidney replacement therapy. Data were extracted on ECHO: economic (e.g. healthcare-associated costs), clinical (e.g. mortality) and humanistic (e.g. patient satisfaction) outcomes. Where appropriate, a random-effects model meta-analysis generated a pooled estimate of effect. A direction of effect plot was used to summarize the overall effects for clinical outcome domains.
Thirty-two RCTs reported a total of 10 economic, 211 clinical and 18 humanistic outcomes. Pharmacist interventions resulted in statistically significant improvements in systolic blood pressure and hemoglobin levels, but not in diastolic blood pressure, estimated glomerular filtration rate, creatinine and low-density lipoprotein cholesterol levels. Mixed findings were reported for clinical and economic outcomes, whilst pharmacist interventions resulted in an improvement in humanistic outcomes such as patient satisfaction and patient knowledge.
Findings showed pharmacist interventions had mixed results for various outcomes. Future studies should be more robustly designed and take into consideration the role of the pharmacist in prescribing and deprescribing, the findings of which will help inform research and clinical practice.
The review was prospectively registered on PROSPERO (CRD42022304902).
药剂师凭借其治疗知识，在管理慢性肾脏病（CKD）患者方面具有独特优势。关于药剂师干预对经济、临床和人文结局（ECHO）的影响，数据有限。
对有药剂师参与的干预措施的随机对照试验（RCT）进行了系统评价和荟萃分析，纳入了诊断为CKD的成年人，包括接受和未接受肾脏替代治疗的患者。提取了关于ECHO的数据：经济结局（如医疗相关成本）、临床结局（如死亡率）和人文结局（如患者满意度）。在适当情况下，采用随机效应模型荟萃分析得出效应的合并估计值。使用效应方向图总结临床结局领域的总体效应。
32项RCT共报告了10项经济结局、211项临床结局和18项人文结局。药剂师干预使收缩压和血红蛋白水平有统计学意义的改善，但舒张压、估计肾小球滤过率、肌酐和低密度脂蛋白胆固醇水平未改善。临床和经济结局的结果不一，而药剂师干预使患者满意度和患者知识等人文结局得到改善。
研究结果表明，药剂师干预在各种结局方面结果不一。未来的研究应设计得更加严谨，并考虑药剂师在处方和减药方面的作用，其研究结果将有助于为研究和临床实践提供信息。
该评价已在PROSPERO（CRD42022304902）上进行前瞻性注册。
