Category: Professional Posters
Purpose: End stage renal disease (ESRD) patients require complex treatment regimens to address complications like anemia and bone mineral disorder (BMD) that would benefit from a multidisciplinary approach. Adherence to treatment regimens is challenging due to cost, side effects, frequent dose adjustments, and regimen complexity. Pharmacists are trained to manage these challenges. The purpose of this study was to evaluate the impact of clinical pharmacist utilizing a phosphate binder, ferric citrate, to improve phosphate control in dialysis patients. Secondary objectives included stabilizing patients’ hemoglobin (Hgb), reducing the usage of erythropoietin-stimulating agents (ESAs) and intravenous (IV) iron, and improving quality of life(QoL).
Methods: In October 2016, the Institutional Review Board approved this single site, retrospective, observational and informational study for the adult patients who were diagnosed with ESRD at least three months prior to the screening visit. Eligible patients had to be on any commercially available phosphate binder prior the enrollment and have a life expectancy greater than one year. Study design consists of a baseline visit and 12 months of treatment period followed by 12 months of follow up. For comparison purposes, 3 months of the retrospective data was collected for enrolled patients. The clinical pharmacist directed interventions included: monitoring of patients’ laboratory parameters; dosing of ferric citrate, ESAs, IV iron, and doxercalciferol utilizing hospital approved protocols; collection of QoL at baseline and quarterly thereafter. Clinical pharmacist ensures the transition of care upon completion of the study. The study began in March of 2017. Currently we are in the follow up phase of data collection until February 2020. The impact of pharmacist intervention utilizing ferric citrate was examined using the paired t-test.
Results: Thirty-one patients (65% males, 51% aged > 55 years) were enrolled out of 101 screened at our Schwartz Dialysis unit at St. Mary’s Medical Center. Eighty-two percent were Medicaid and/or Medicare beneficiaries. Results of the paired t-test showed that the declining phosphorous levels trend towards statistical significance (i.e. p values move from p=.740 PO4 6.5 mg/dl at Visit 1 to p=.060 PO4 4.9 mg/dl at Visit 12). At week 12, 16 patients use of IV iron decreased substantially from 468.75 mg/month to 250.00 (p<0.05). Usage of ESAs for patients fluctuated monthly. Seventy-four percent of patients achieved the goal of Hgb>10 g/dL. Mean scores for the QoL questionnaire increased, but there was no statistically significant difference between visits (QoL ranged from 36-39 physical scores and 45-49 mental scores).
Conclusion: The community standard for chronic dialysis facilities is to have a medical director, nephrologists, dialysis nurses, technicians, a dietitian and social worker. Typically, no pharmacist is present. With the implementation of a pharmacist as part of the dialysis interdisciplinary team at St. Mary’s Medical Center, the number of anemic patients was reduced. The usage of IV iron has declined. Additionally, the pharmacist involvement in multidisciplinary patient assessment meetings, patient education, medication reconciliation and transition of care provides better patient understanding and adherence. The initial results of the pharmacist’s role in ESRD patients care are promising for clinical and economic outcomes