Pharmacists involved in guidance for kidney disease treatment evaluate laboratory test results and medication history for both outpatients and inpatients in order to encourage more appropriate usage, change to other drugs when necessary, optimize prescriptions, or improve medication adherence. Here we retrospectively investigated the effects of interventions conducted by pharmacists in patients with pre-dialysis kidney disease.
\nWe reviewed medical records of patients referred to the nephrology department of Kouseikai Hospital from April 2015 to March 2019 and who had continued hospital follow-up visits for more than 3 months with at least two measurements of renal function assessment using estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). We compared changes in renal function between 44 cases from April 2015 to March 2017 (non-pharmacist group) and 45 cases from April 2017 to March 2019 (pharmacist intervention group).
\nComparison of eGFR 3 months later showed no difference in improvement of renal function between the non-pharmacist group and the pharmacist intervention group, but eGFR in the non-pharmacist group tended to decrease. In patients with more than 10% improvement in eGFR, the pharmacist intervention group showed a significantly higher improvement rate of 33% compared with 11% in the non-pharmacist group (p = 0.03). Pharmacist interventions included 8 cases with instructions to improve medication adherence, 5 cases with withdrawal of vitamin D prescribed by other medical institutions, 2 cases with a recommended change from prescribed regular nonsteroidal anti-inflammatory drugs, and 3 cases with a recommendation to improve blood pressure control. Our findings suggest that pharmacists working with doctors to optimize laboratory test values and prescription content and to improve adherence in patients with pre-dialysis kidney disease would lead to elimination of factors associated with worsening renal function and would thus prevent renal function decline.
"},{"@language":"ja","@value":"腎臓病療養指導において薬剤師は外来・入院を問わず検査値と薬歴を調査し、より適正な使用量・他剤への変更依頼、処方内容の適正化または服薬アドヒアランス向上などに努めている。今回、薬剤師による保存期腎臓病患者を対象とした腎臓病療養指導における介入の効果を後方視的に調査した。
2015年4月-2019年3月に光晴会病院腎臓内科へ紹介のあった患者から、3か月以上継続して通院し、推算糸球体濾過量(estimated glomerular filtration rate; eGFR) を2回以上測定した2015年4月-2017年3月の薬剤師非介入群44例と2017年4月-2019年3月の薬剤師介入群45例の腎機能の変化を比較した。
腎機能eGFRの3か月後の比較では薬剤師非介入群と介入群の両群の腎機能の改善には差がみられなかったが、薬剤師非介入群ではeGFRが低下する傾向がみられた。eGFRが10％以上改善した患者を比較すると薬剤師非介入群は5例11％、薬剤師介入群15例33％で薬剤師介入群の方が有意に改善率が高かった（p=0.03）。薬剤師の介入は服薬アドヒアランス向上のための服薬指導8例、他の医療機関からのビタミンD製剤中止が5例、NSAIDs定時処方から頓用への変更2例、血圧コントロールの改善3例であった。保存期腎臓病患者に対して、薬剤師が医師と協働して検査値と処方内容の適正化、服薬アドヒアランス向上に努めることは腎機能悪化要因の除去につながり腎機能の悪化防止につながることが示唆された。
"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410004222634369666","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000410463010"}],"foaf:name":[{"@language":"en","@value":"Narisue Masami"},{"@language":"ja","@value":"成末 まさみ"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Pharmacy, Kouseikai Hospital"},{"@language":"ja","@value":"光晴会病院薬剤科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410004222634369538","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000410463011"}],"foaf:name":[{"@language":"en","@value":"Sugimoto Yuka"},{"@language":"ja","@value":"杉本 悠花"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Pharmacy, Kouseikai Hospital"},{"@language":"ja","@value":"光晴会病院薬剤科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410004222634369536","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000410463012"}],"foaf:name":[{"@language":"en","@value":"Nakatsukasa Risa"},{"@language":"ja","@value":"中司 梨紗"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"光晴会病院薬剤科"},{"@language":"en","@value":"Department of Pharmacy, Kouseikai Hospital"}]},{"@id":"https://cir.nii.ac.jp/crid/1410004222634369667","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000410463013"}],"foaf:name":[{"@language":"en","@value":"Hirano Fumi"},{"@language":"ja","@value":"平野 史"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Pharmacy, Kouseikai Hospital"},{"@language":"ja","@value":"光晴会病院薬剤科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410004222634369664","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000410463014"}],"foaf:name":[{"@language":"en","@value":"Miyazaki Kenichi"},{"@language":"ja","@value":"宮崎 健一"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Nephrology, Kouseikai Hospital"},{"@language":"ja","@value":"光晴会病院腎臓内科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410004222634369665","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000410463015"}],"foaf:name":[{"@language":"en","@value":"Otsubo Toshio"},{"@language":"ja","@value":"大坪 俊夫"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Nephrology, Kouseikai Hospital"},{"@language":"ja","@value":"光晴会病院腎臓内科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410004222634369537","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000410463016"}],"foaf:name":[{"@language":"en","@value":"Hirata Sumio"},{"@language":"ja","@value":"平田 純生"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"熊本大学薬学部附属育薬フロンティアセンター・臨床薬理分野"},{"@language":"en","@value":"Division of Clinical Pharmacology, Center for Clinical Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Kumamoto University"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"21870411"},{"@type":"EISSN","@value":"21898014"},{"@type":"NDL_BIB_ID","@value":"023537144"},{"@type":"ISSN","@value":"21870411"},{"@type":"LISSN","@value":"21870411"},{"@type":"NCID","@value":"AA12646668"}],"prism:publicationName":[{"@language":"ja","@value":"日本腎臓病薬物療法学会誌"},{"@language":"en","@value":"The Japanese Journal of Nephrology and Pharmacotherapy"},{"@language":"ja","@value":"日腎薬誌"},{"@language":"en","@value":"Jpn J Nephrol Pharmacother"}],"dc:publisher":[{"@language":"en","@value":"The Japanese Society of Nephrology and Pharmacotherapy"},{"@language":"ja","@value":"一般社団法人 日本腎臓病薬物療法学会"}],"prism:publicationDate":"2020","prism:volume":"9","prism:number":"2","prism:startingPage":"165","prism:endingPage":"172"},"url":[{"@id":"http://id.ndl.go.jp/bib/030582239"},{"@id":"https://ndlsearch.ndl.go.jp/books/R000000004-I030582239"},{"@id":"https://search.jamas.or.jp/link/ui/2020348017"}],"availableAt":"2020","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E8%85%8E%E8%87%93%E7%97%85%E7%99%82%E9%A4%8A%E6%8C%87%E5%B0%8E","dc:title":"腎臓病療養指導"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%96%AC%E5%AD%A6%E7%9A%84%E4%BB%8B%E5%85%A5","dc:title":"薬学的介入"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%85%8E%E6%A9%9F%E8%83%BD","dc:title":"腎機能"},{"@id":"https://cir.nii.ac.jp/all?q=%E6%85%A2%E6%80%A7%E8%85%8E%E8%87%93%E7%97%85","dc:title":"慢性腎臓病"},{"@id":"https://cir.nii.ac.jp/all?q=%E4%BF%9D%E5%AD%98%E6%9C%9F%E8%85%8E%E8%87%93%E7%97%85%E6%82%A3%E8%80%85","dc:title":"保存期腎臓病患者"},{"@id":"https://cir.nii.ac.jp/all?q=kidney%20disease%20treatment%20guidance","dc:title":"kidney disease treatment guidance"},{"@id":"https://cir.nii.ac.jp/all?q=pharmaceutical%20intervention","dc:title":"pharmaceutical intervention"},{"@id":"https://cir.nii.ac.jp/all?q=renal%20function","dc:title":"renal function"},{"@id":"https://cir.nii.ac.jp/all?q=chronic%20kidney%20disease","dc:title":"chronic kidney disease"},{"@id":"https://cir.nii.ac.jp/all?q=patients%20with%20pre-dialysis%20kidney%20disease","dc:title":"patients with pre-dialysis kidney disease"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2008088826"},{"@type":"NDL_SEARCH","@value":"oai:ndlsearch.ndl.go.jp:R000000004-I030582239"},{"@type":"CIA","@value":"130007925474"}]}