College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
Nova Scotia Health Research and Innovation, Halifax, NS, Canada.
BMC Nephrol. 2024 Oct 29;25(1):386. doi: 10.1186/s12882-024-03829-y.
Community pharmacists commonly see individuals with chronic kidney disease (CKD) and are in an ideal position to mitigate harm from inappropriate prescribing. We sought to develop a relevant medication list for community pharmacists to dose adjust or avoid in individuals with an estimated glomerular filtration rate (eGFR) below 30 mL/min informed through a scoping review and modified Delphi panel of nephrology, geriatric and primary care pharmacists.
A scoping review was undertaken to identify higher risk medications common to community pharmacy practice, which require a dose adaptation in individuals with advanced CKD. A 3-round modified Delphi was conducted, informed by the medications identified in our scoping review, to establish consensus on which medications community pharmacists should adjust or avoid in individuals with stage 4 and 5 CKD (non-dialysis).
Ninety-two articles and 88 medications were identified from our scoping review. Of which, 64 were deemed relevant to community pharmacy practice and presented for consideration to 27 panel experts. The panel consisted of Canadian pharmacists practicing in nephrology (66.7%), geriatrics (18.5%) and primary care (14.8%). All participants completed rounds 1 and 2 and 96% completed round 3. At the end of round 3, the top 40 medications to adjust or avoid were identified. All round 3 participants selected metformin, gabapentin, pregabalin, non-steroidal anti-inflammatory drugs, nitrofurantoin, ciprofloxacin and rivaroxaban as the top ranked medications.
Medications eliminated by the kidneys may accumulate and cause harm in individuals with advanced chronic kidney disease. This study provides an expert consensus of the top 40 medications that community pharmacists should collaboratively adjust or avoid to enhance medication safety and prescribing for individuals with an eGFR below 30 mL/min.
社区药剂师通常会接诊患有慢性肾脏病（CKD）的患者，他们处于一个理想的位置，可以减轻不适当处方带来的危害。我们试图通过系统评价和肾脏病学、老年病学和初级保健药剂学专家的修改德尔菲小组，为社区药剂师制定一份相关的药物清单，以便在肾小球滤过率（eGFR）估计值低于 30 mL/min 的个体中调整剂量或避免使用这些药物。
进行了一项系统评价，以确定在社区药房实践中常见的、需要在晚期 CKD 患者中调整剂量的高风险药物。进行了三轮修改后的德尔菲法，根据我们的系统评价中确定的药物，就社区药剂师在 4 期和 5 期 CKD（非透析）患者中应调整或避免使用哪些药物达成共识。
从我们的系统评价中确定了 92 篇文章和 88 种药物。其中，有 64 种药物被认为与社区药房实践相关，并提交给 27 名专家小组讨论。专家组由在肾脏病学（66.7%）、老年病学（18.5%）和初级保健（14.8%）领域从事药剂工作的加拿大药剂师组成。所有参与者都完成了第 1 轮和第 2 轮，96%的参与者完成了第 3 轮。在第 3 轮结束时，确定了前 40 种需要调整或避免的药物。所有第 3 轮参与者都选择了二甲双胍、加巴喷丁、普瑞巴林、非甾体抗炎药、呋喃妥因、环丙沙星和利伐沙班作为排名最高的药物。
肾脏清除的药物可能在晚期慢性肾脏病患者中积聚并造成伤害。本研究提供了社区药剂师应共同调整或避免使用的前 40 种药物的专家共识，以增强 eGFR 低于 30 mL/min 的个体的药物安全性和处方。
