Hospital Pharmacy - November 2017 - 663

733561
editorial2017

HPXXXX10.1177/0018578717733561Hospital PharmacyKane-Gill and Bauer

Editorial

AKD-The Time Between
AKI and CKD: What Is the Role
of the Pharmacist?

Hospital Pharmacy
2017, Vol. 52(10) 663-665
© The Author(s) 2017
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https://doi.org/10.1177/0018578717733561
DOI: 10.1177/0018578717733561
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Sandra L. Kane-Gill1 and Seth R. Bauer2

Recently, the Acute Disease Quality Initiative (ADQI)
workgroup published a consensus statement describing
acute kidney disease (AKD) being the 7 to 90 days between
the progression of acute kidney injury (AKI) to chronic
kidney disease (CKD).1 It is important to realize the substantial risk of developing CKD after AKI. According to a
meta-analysis, the pooled hazard ratio for developing CKD
following an episode of AKI was 8.8 (95% confidence
interval: 3.1-25.5).2 Even patients whose serum creatinine
returns to baseline following an AKI episode have the possibility of progressing to CKD.3 Considering drug-associated AKI, residual kidney damage is noted in 70% of
patients at 6 months.4 Many factors possibly contribute to
the progression of AKI to CKD including nephron loss,
endothelial injury, vascular insufficiency, interstitial
inflammation and fibrosis, cell cycle disturbance, and maladaptive repair mechanisms.5
There is a need for better follow-up care after an AKI
episode, and there is a need for improvement in health literacy for kidney disease. Notably, 80% of patients are
unaware that they experienced an episode of AKI in the hospital.6 Furthermore, only 8% to 41% of patients receiving
dialysis in the hospital see a nephrologist within 1 year of
hospital discharge.7-9 Even those patients who received dialysis in the hospital and recovered adequately to not require
dialysis do not typically visit a nephrologist.10 Follow-up
with a nephrologist is imperative because it is associated
with improved mortality.8
The role of the pharmacist in patients with AKD has not
been described, possibly due to the lack of AKD awareness.
Pharmacists are actively involved in the management of
drugs during an AKI episode and also for patients at high risk
for AKI in the community.11-13 Pharmacists also participate
in dialysis clinics for the care of patients requiring dialysis14,15
and in ambulatory care settings to manage drugs in CKD

patients.16,17 Because of these services, the involvement of
pharmacists in the care of patients with AKD is a natural
extension. Table 1 describes the potential role for pharmacists in caring for patients with AKD. Implementation of
these services can help bridge the noted gaps in health literacy and follow-up.

Summary
The role of pharmacists in caring for patients with AKD
(1) begins with inpatient care at the time of AKI diagnosis, (2) involves patient-pharmacist interaction at hospital
discharge, and (3) provides active follow-up care after
hospital discharge. The pharmacist, as part of a multiprofessional patient care team, should be actively involved
in improving health literacy for kidney disease, should be
encouraging patient follow-up after an episode of AKI,
and should be actively involved in medication management for patients with AKD. This role is similar to a pharmacist caring for a patient with AKI or CKD because of
the central focus on optimal medication management;
however, it is different because of the emphasis on
enhancing health literacy for kidney disease, preventing
progression to CKD, and developing a process for continuity of care.

1

University of Pittsburgh, PA, USA
Cleveland Clinic, OH, USA

2

Corresponding Author:
Sandra L. Kane-Gill, Department of Pharmacy and Therapeutics, School of
Pharmacy, University of Pittsburgh, Pittsburgh, PA 15260, USA.
Email: Kane-Gill@pitt.edu
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