Table 1.
Role of pharmacist | Description of the problem | Potential action |
---|---|---|
Enhancing health literacy about managing medications during AKD | Only 12% of patients thought the kidneys process medicines18 | Educate patients at hospital discharge Reach out to patients via telemedicine in their homes Meet with patients in post-AKI ambulatory clinics6,10,19 |
Managing drug dosing | Almost 5 million ambulatory care visits occur every year due to adverse drug events, and often, these are due to preventable medication errors20 | 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 |
Avoiding nephrotoxins post AKI | 20% of patients with a recent episode of AKI take nonsteroidal anti-inflammatory drugs21 | 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 |
Cautiously restarting necessary nephrotoxins | Timing the initiation of nephrotoxins post-AKI requires a balance | 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 |
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 | Serum creatinine and urine albumin monitoring after hospital discharge Testing recovery biomarkers when ready for clinical practice24 |
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. | 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.