Slowing Kidney Deterioration in Patients with Chronic Kidney Disease Stages 3–5 at Kidney Preservation Clinic in a General Hospital

Abstract

Background: The pharmaceutical care provided by pharmacists in collaboration with a multidisciplinary team has shown promise in delaying kidney deterioration and prolonging the need for renal replacement therapy.

Objectives: This study aimed to evaluate the outcomes based on the indicators of the service plan for nephrology in 2021, in conjunction with medication adherence with chronic kidney disease (CKD) attending a kidney clinic.

Method: A descriptive, cross-sectional study was conducted involving patients with CKD stages 3B-5 at a general hospital from October 2021 to September 2022. General demographic data and laboratory results were collected according to the 13 key performance indicators outlined by the nephrology indicators in 2021. Medication adherence was assessed by counting remaining pills and utilizing the MTB-Thai adherence questionnaire. Data were analyzed using descriptive statistics, including frequency percentage, mean, and standard deviation.

Results: Among the 112 patients with CKD stages 3B–5, assessment of 13 nephrology key performance indicators showed that more than 80% of patients met the target criteria for six indicators: BP <140/90 mmHg, a decline in eGFR of less than 5 mL/min/1.73 m² per year, serum K <5.5 mEq/L, serum PO₄ ≤4.6 mg%, having urine protein screening, and having UPCR assessment. In contrast, only approximately 70% of patients were prescribed ACEI/ARB and statin therapy. Additionally, only 60% met the target for serum HCO₃ >22 mEq/L. Medication adherence was observed in 50.9% of the patients.

Conclusion: The service plan indicators for nephrology in CKD clinic, where patients receive care through the pharmaceutical care process provided by pharmacists in collaboration with a multidisciplinary team, meet the criteria including BP <140/90, use of ACEI/ARB, a decline in eGFR of less than 5 mL/min/1.73 m² per year, Hb >10 g/dL, Hct >33%, Hb_A1c between 6.5-7.5%, statin use, serum K <5.5 mEq/L, urine protein screening, UPCR assessment, UPCR <500 mg/g creatinine, and serum PO₄ ≤4.6 mg%.