Hospital Pharmacy - November 2017 - 664

664

Hospital Pharmacy 52(10)

Table 1. Role of the Pharmacist in Care for Patients with AKD as part of a patient care team.
Role of pharmacist

Description of the problem

Potential action

Enhancing health literacy
about managing
medications during AKD
Managing drug dosing

Only 12% of patients thought the kidneys
process medicines18

Avoiding nephrotoxins
post AKI

20% of patients with a recent episode of AKI
take nonsteroidal anti-inflammatory drugs21

Cautiously restarting
necessary nephrotoxins

Timing the initiation of nephrotoxins post-AKI
requires a balance

Working with patient
care team to encourage
monitoring

Only about 25% of patients with risk factors
for AKI saw a nephrologist within 3 months
of the AKI episode23

Managing diabetes and
hypertension as part of a
patient care team

Risks for developing AKI include diabetes
mellitus and history of hypertension.25 The
risk factors for AKD are not substantiated
but are possibly similar to AKI.

Almost 5 million ambulatory care visits occur
every year due to adverse drug events,
and often, these are due to preventable
medication errors20

Educate patients at hospital discharge
Reach out to patients via telemedicine in their homes
Meet with patients in post-AKI ambulatory clinics6,10,19
Active involvement in medication management during
the hospital stay and at hospital discharge
Reach out to patients via telemedicine to perform
medication reconciliation
Meet with patients in post-AKI ambulatory clinics6,10,19
Monitor patients in the hospital and intervene as
necessary
Educate patients at hospital discharge
Reach out to patients via telemedicine in their homes
Meet with patients in post-AKI ambulatory clinics6,10,19
Guidance on initiating angiotensin-converting enzyme
inhibitors and angiotensin II receptor blockers is
provided by the National Health Services of England
in their program "Think Kidneys"22
Serum creatinine and urine albumin monitoring after
hospital discharge
Testing recovery biomarkers when ready for clinical
practice24
Active involvement in hospital patient care rounds,
ambulatory clinics, and community care for chronic
medication management

Note. AKD = acute kidney disease; AKI = acute kidney injury.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

References
1. Chawla LS, Bellomo R, Bihorac A, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease
Quality Initiative (ADQI) 16 workgroup. Nat Rev Nephrol.
2017;13:241-257.
2. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease
after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442-448.
3. Pannu N, James M, Hemmelgarn B, Klarenbach S. Alberta
Kidney Disease Network. Association between AKI, recovery
of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol. 2013;8:194-202.
4. Menon S, Kirkendall ES, Nguyen H, Goldstein SL. Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months. J Pediatr.
2014;165(3):522-527.
5. Chaturvedi S, Ng KH, Mammen C. The path to chronic kidney
disease following acute kidney injury: a neonatal perspective.
Pediatr Nephrol. 2017;32:227-241.

6. Silver SA, Siew ED. Follow-up care in acute kidney injury: lost
in transition. Adv Chronic Kidney Dis. 2017;24(4):246-252.
7. Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Longterm risk of mortality and other adverse outcomes after acute
kidney injury: a systematic review and meta-analysis. Am J
Kidney Dis. 2009;53:961-973.
8. Harel Z, Wald R, Bargman J, et al. Nephrologist follow-up
improves all-cause mortality of severe acute kidney injury survivors. Kidney Int. 2013;83:901-908.
9. Kirwan CJ, BLuden MJ, Dobbie H, James A, Nedungadi A,
Prowle JR. Critically ill patients requiring acute renal replacement therapy are at an increased risk of long-term renal dysfunction, but rarely receive specialist nephrology follow-up.
Nephron. 2015;129:164-170.
10. Silver SA, Goldstein SL, Harel Z, et al. Ambulatory care after
acute kidney injury: an opportunity to improve patient outcomes. Can J Kidney Health Dis. 2015;2:36.
11. Kielstein JT, Burkhardt O. Dosing of antibiotics in critically
ill patients undergoing renal replacement therapy. Curr Pharm
Biotechnol. 2011;12:2015-2019.
12. Jang SM, Cerulli J, Grabe DW, et al. NSAID-avoidance education in community pharmacies for patients at high risk for
acute kidney injury, upstate New York, 2011. Prev Chronic
Dis. 2014;11:E220.
13. Pai AB. Keeping kidneys safe: the pharmacist's role in
NSAID avoidance in high-risk patients. J Am Pharm Assoc.
2015;55:e15-e23.
14. Aspinall SL, Smith KJ, Good CB, et al. Incremental cost effectiveness of pharmacist-managed erythropoiesis-stimulating

Table of Contents for the Digital Edition of Hospital Pharmacy - November 2017