The role of clinical pharmacy services in achieving treatment targets in Iranian haemodialysis patients

Dashti-Khavidaki S, Khalili H, Shahverdi S, Abbasi MR, Lessan-Pezeshki M
Correspondence: Dr Simin Dashti-Khavidaki, dashtis@sina.tums.ac.ir

ABSTRACT
Introduction The number of patients suffering from chronic kidney disease (CKD) is increasing worldwide. Hyperphosphataemia and high serum calcium (Ca) and phosphorus (P) product contribute to the substantial increase in cardiovascular events in CKD patients. Although reports of CKD complications in Iranian haemodialysis (HD) patients are comparable to data from other developed countries, management of these complications has failed to meet generally accepted targets. This study evaluated the impact of clinical pharmacy services in the management of complications in HD patients.
Methods During a six-month prospective study, clinical pharmacists conducted medical visits in the HD ward and adjusted the patients’ medications according to their laboratory findings.
Results Serum Ca concentration was increased in hypocalcaemia patients and decreased in hypercalcaemia patients until it reached the optimal range in both groups. A decline in serum P level was noted in hyperphosphataemia patients, although it did not reach the target range. The Ca × P product decreased in patients with Ca × P > 55 mg²/dL². Although it did not reach the goal, there was an increase and decrease in serum intact parathyroid hormone (iPTH) concentration in suboptimal and supraoptimal range patients, respectively. Serum Ca, P and iPTH levels did not change in patients with optimal values at the initiation of the study. Haemoglobin concentration increased in anaemic patients and serum ferritin reached target values in all patients. Total cholesterol, low-density lipoprotein cholesterol and triglycerides decreased to near-optimal values in dyslipidaemia patients.
Conclusion This study showed that clinical pharmacy services at the HD centre can improve the management of complications in CKD patients.

Keywords: anaemia, dyslipidaemia, haemodialysis, hyperparathyroidism, NKF-K/DOQI guidelines
Singapore Med J 2012; 53(9): 599–603