A Study to assess the improvement of management outcomes in chronic kidney disease of uncertain etiology by introducing clinical pharmacy services to selected out patient renal clinics in the north central province Sri Lanka

Abstract

OBJECTIVES: To assess impact of “clinic-based pharmacist’ services on drug adherence and health outcomes in stage 4 or 5 pre-dialysis Chronic Kidney Disease of uncertain etiology (CKDu) patients in an out-patient renal clinic in North Central Province, Sri Lanka. METHODOLOGY: A randomized controlled clinical trial was conducted in Teaching Hospital, Anuradhapura. Demography, drug adherence (using BMQ Score), management outcomes, and Quality of Life (using KDQOL-SF™) were assessed. Intervention(I) group received four counseling sessions by a “clinic-based pharmacist” plus usual clinic care over 12 months. Control (C) group received usual care. RESULTS: Of 256 eligible patients, 127 were allocated to C and 129 to I. Demography and baseline outcome measures were similar. At 12 months, median BMQ scores improved from 5(3-5) to 3(2-4) (p<0.050), mean hemoglobin (Hb) levels improved from 11.02±1.44g/dL to 11.41±1.37g/dL (p<0.050) and QOL improved in I group. In C group, mean diastolic blood pressure and mean serum creatinine increased and eGFR was reduced, but those outcomes were unaltered in I group. CONCLUSION: “Clinic-based pharmacist” services improved drug adherence, Hb levels and QOL in stage 4 or 5 pre-dialysis CKDu patients. This service can improve disease outcomes.