Pogson Cathy Margaret, Austin Rosalynn, Patel Jignesh Prakash, Wheeler David Collins
Pharmacy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Br J Clin Pharmacol. 2025 Apr;91(4):1132-1156. doi: 10.1111/bcp.16363. Epub 2024 Dec 30.
Structured medication reviews (SMRs) were introduced into the National Health Service (NHS) Primary Care to support the delivery of the NHS Long-Term Plan for medicines optimization. SMRs improve the quality of care, reduce harm and offer value for money. However, evidence to support SMRs for patients with chronic kidney disease (CKD) stage G4-5D with elevated risk of cardiovascular disease and premature mortality is unknown. This scoping review aimed to assess the extent and nature of SMR research in the population of patients with CKD stage G4-5D. Electronic databases were searched on 20 October 2023. Studies were eligible if they described an SMR in adults with CKD stage G4-5D, regardless of the study design. Data detailing the global patterns, population and intervention descriptions, professionals performing SMR, and reported areas for future research were extracted. The extracted outcome data were categorized as clinical, patient-important, medication-related and experience-related. A narrative synthesis was completed. Seventeen studies (81%) were conducted in nephrology outpatient settings, three (14%) during acute hospital admissions and one (5%) within the community pharmacy. Eighteen studies (86%) were quantitative, including five randomized controlled trials. Ten (48%) studies were undertaken in the United States and Canada, and two in Europe (France and Norway). No such studies have been conducted in the United Kingdom. Our review revealed that there is a lack of evidence for SMR as a strategy to reduce polypharmacy and harms from medication for adults with CKD stage G4-5D. Therefore, further research is required in this area.
结构化药物评估（SMRs）已被引入英国国家医疗服务体系（NHS）的初级保健中，以支持NHS长期药品优化计划的实施。SMRs可提高护理质量、减少伤害并提供性价比。然而，对于患有慢性肾脏病（CKD）G4-5D期且心血管疾病风险和过早死亡率升高的患者，支持SMRs的证据尚不清楚。本综述旨在评估CKD G4-5D期患者中SMR研究的范围和性质。于2023年10月20日检索了电子数据库。如果研究描述了针对CKD G4-5D期成人的SMR，则符合纳入标准，无论其研究设计如何。提取了详细说明全球模式、人群和干预描述、进行SMR的专业人员以及报告的未来研究领域的数据。提取的结果数据分为临床、对患者重要、与药物相关和与经验相关四类。完成了叙述性综合分析。17项研究（81%）在肾病门诊进行，3项（14%）在急性住院期间进行，1项（5%）在社区药房进行。18项研究（86%）是定量研究，包括5项随机对照试验。10项（48%）研究在美国和加拿大进行，2项在欧洲（法国和挪威）进行。英国尚未进行此类研究。我们的综述表明，缺乏证据支持将SMR作为减少CKD G4-5D期成人多重用药和药物伤害的策略。因此，该领域需要进一步研究。
