Pharmacists in Alberta, Canada, who screened at-risk patients for chronic kidney disease (CKD) found that 1 in every 6.4 tested had the disease, including a fair number who had not been diagnosed. The study underscored the importance both of providing easier access to testing and training community pharmacists to use such tests and interpret the results.
“It was actually surprising for us,” the study’s primary author, Dr. Yazid Al Hamarneh, a pharmacist and the scientific officer for Consultation and Research Services in Alberta’s SPOR (Strategy for Patient-Oriented Research) SUPPORT Unit, said in a press release. “We knew that we would find unrecognized cases, but not that many.”
The study was titled “Community pharmacist targeted screening for chronic kidney disease,” and published in the Canadian Pharmacists Journal.
Early detection of CKD can help optimize treatment, prevent or slow disease progression, and ultimately improve the quality of a patient’s life. Early stage CKD is often asymptomatic, and a large proportion of these patients can go undiagnosed or under-diagnosed during this period.
Researchers evaluated an online decision-making tool, “CKD Pathway,” used to help primary care providers decide which patients to test, to identify cases, and to give patients with the disease appropriate lifestyle advice, medication, or a nephrologist referral. “We worked closely with our end-users — primary care physicians, pharmacists and nurses. It took about a year to develop the pathway and was launched one year ago,” said Dr. Brenda Hemmelgarn, a nephrologist involved in the pathway and a study co-author.
Pharmacists at 55 different community pharmacies in Alberta identified patients at risk of CKD based on the data retrieved from lab tests as well as from recent medication prescriptions. Those who had risk factors were sent for blood and urine tests of kidney function. The online CKD pathway was used to evaluate test results and establish patients’ CKD status.
In the study, 720 at-risk patients were screened and 39 percent were found to have CKD. Of these patients, 60% had received a CKD diagnosis but 40 percent had not. “Pharmacists as front-line care providers are in a unique position to identify high-risk patients for CKD, do targeted screening through blood and urine tests, and identify the presence of CKD. They have a unique position in Alberta to participate in care of patients with chronic disease at the community level,” Dr. Hemmelgarn said.
Community pharmacists’ application of the CKD Pathway in at-risk patients revealed a high proportion with unrecognized CKD, the authors said, and the tool represents a promising approach for targeted screening with implications for chronic disease prevention and management.
Knowing the CDK status of a patient is relevant for pharmacists, Dr. Al Hamarneh said, as certain medicines can be contraindicated for those suffering with kidney problems. “When it comes to pharmacists providing such clinical services, it’s not taking patients away from family physicians,” he said. “Pharmacists see patients with chronic diseases frequently. If the pharmacists are providing those clinical services, they can bring those patients back to their physicians. … It’s working collaboratively to get the best results for the patient.”