Weltman Melanie R, Han Zhuoheng, Lavenburg Linda-Marie U, Alghwiri Alaa A, Yabes Jonathan G, Nolin Thomas D, Jhamb Manisha
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
Kidney Med. 2025 Mar 18;7(5):100995. doi: 10.1016/j.xkme.2025.100995. eCollection 2025 May.
RATIONALE & OBJECTIVE: Medication therapy problems (MTPs) are therapeutic issues related to medications that may cause undesirable events. People with chronic kidney disease (CKD) are at high risk of experiencing MTPs owing to comorbid conditions and medication burden. This study characterizes MTPs in individuals enrolled in the Kidney Coordinated Health Management Partnership trial and evaluates the intervention's effect on MTPs.
Post hoc analysis of a pragmatic, cluster-randomized trial.
SETTING & PARTICIPANTS: Individuals aged 18-85 years with an estimated glomerular filtration rate of <60 mL/min/1.73 m, moderate to high risk of CKD progression, and not seeing a nephrologist enrolled from 101 primary care practices (May 2019 to November 2021).
Electronic health record-based multidisciplinary care including nephrology e-consult, pharmacist medication review, and patient education at baseline and every 6 months.
MTP type and frequency of occurrence were characterized along with associated medication classes. Descriptive statistics of MTPs were conducted, and cumulative probabilities of resolution over time were estimated using the discrete-time survival method.
Baseline medication reviews were completed by telephone (52%) or chart review (48%) in 730 out of 754 (97%) intervention-arm participants (mean age, 74 ± 9 years and estimated glomerular filtration rate, 37 ± 8 mL/min/1.73 m). Polypharmacy was evident in 63% of participants. At baseline, 78% had MTPs and 79% had medication discrepancies. The most common MTP was indication without drug therapy, associated with sodium-glucose cotransporter-2 (SGLT-2) inhibitors. The average number of MTPs per participant decreased from 2.01 at baseline to 1.28 at 6 months (36% reduction), and 1.15 at 12 months (43% reduction). Based on the discrete-time survival model, an estimated 92% of MTPs were resolved by 12 months.
Medication management was not completed for control-arm participants. No standardized tool was used to assess medication adherence. We relied on electronic health record chart review to identify MTPs in participants who could not be reached by telephone.
MTPs and medication discrepancies are highly prevalent in nondialysis-dependent CKD. Medication management through multidisciplinary team care can optimize medication therapy in CKD.
药物治疗问题（MTPs）是与药物相关的治疗问题，可能导致不良事件。慢性肾脏病（CKD）患者由于合并症和药物负担，发生MTPs的风险很高。本研究描述了参与肾脏协调健康管理伙伴关系试验的个体中的MTPs，并评估了干预措施对MTPs的影响。
对一项实用的整群随机试验进行事后分析。
年龄在18 - 85岁之间，估计肾小球滤过率<60 mL/min/1.73 m²，CKD进展风险为中度至高风险，且未就诊于肾病科医生的个体，从101家初级保健机构招募（2019年5月至2021年11月）。
基于电子健康记录的多学科护理，包括肾病电子会诊、药剂师药物审查以及在基线和每6个月时的患者教育。
在754名干预组参与者中的730名（97%）中，通过电话（52%）或病历审查（48%）完成了基线药物审查（平均年龄74±9岁，估计肾小球滤过率37±8 mL/min/1.73 m²）。63%的参与者存在多重用药情况。在基线时，78%的人有MTPs，79%的人有用药差异。最常见的MTP是有适应证但未进行药物治疗，与钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂相关。每位参与者的MTP平均数量从基线时的2.01降至6个月时的1.28（减少36%），以及12个月时的1.15（减少43%）。基于离散时间生存模型，估计92%的MTPs在12个月时得到解决。
未对对照组参与者完成药物管理。未使用标准化工具评估药物依从性。我们依靠电子健康记录病历审查来识别无法通过电话联系到的参与者中的MTPs。
在非透析依赖的CKD中，MTPs和用药差异非常普遍。通过多学科团队护理进行药物管理可以优化CKD的药物治疗。
