Table 2.

Characteristics of uncontrolled studies included in the systematic review

Study year Country	Study design (duration)	Study setting	Aim	Participants		Pharmacist interventions	Main clinical outcomes achieved
				N (at baseline)	Age (years), mean (SD)
Kelly et al. (2008) United Kingdom [43]	Prospective uncontrolled study (18 months)	Diabetes unit of a secondary hospital	To offer stepwise intensive treatment to patients with diabetic nephropathy picked up at the traditional secondary care clinic	116 diabetic nephropathy patients	63.4 (8.6)	Frequent visits to pharmacist led clinic for treatment optimisation, checking of BP, renal function, HbA1c, ACR, FBC, calcium and phosphate. Medical history taking by two sources	Significant improvements in BP (p < 0.001), total cholesterol (p < 0.001) and HbA1c (p < 0.05)
Dashti-Khavidaki et al. (2009) Iran [51]	Prospective uncontrolled study (12 months)	Nephrology and infectious disease wards of a large university hospital	To understand the types of services provided by clinical pharmacists in nephrology and infectious disease wards, the acceptance by physicians and the clinical significance of these services	1105 CKD patients	52.5 (14.1)	Uniform documentation of all clinical pharmacy residents activities and interventions	Not reported
Vessal (2010) Iran [17]	Prospective uncontrolled study (4 months)	Nephrology ward of a university hospital	To determine the impact of a clinical pharmacist on detection and prevention of prescription errors at the nephrology ward of a referral hospital	76 CKD patients	47.7 (17.2)	CP reviewed medication orders and intervention was made after agreement of the attending physician	Although 89.5% of the detected errors caused no harm, 4(4.7%) of the errors increased the need for monitoring, 2 (2.3%) increased length of stay, and 2 (2.3%) led to permanent patient harm
Castelino et al. (2011) India [29]	Prospective uncontrolled study (8 months)	Department of nephrology of a teaching hospital	To explore the potential clinical significance of the MRPs and the acceptance of recommendations made by clinical pharmacists	308 CKD patients	NR	Medication history interview, clinical and medication review by pharmacist. Recommendation were reported to the health care team	Not reported
Ohnishi et al. (2011) Japan [34]	Retrospective uncontrolled study (12 months)	Outpatient haemodialysis unit of a tertiary hospital	To explore the role of the pharmacists’ participation, we examined the influence of haemoglobin levels anteroposterior the participation	84 HD patients	62	Pharmacists provided drug information on renal anaemia to physicians, performed medication use evaluations based on laboratory data, proposed plans to change prescriptions based on medication use evaluations and provided drug information and lifestyle care point to patients	The counselling by pharmacists significantly decreased haemoglobin levels in the high group (12 g/dl) and significantly increased them in low group (10 g/dL)
Belaiche et al. (2012a) France [21]	Prospective uncontrolled study (6 months)	University hospital based nephrology clinic	To identify DRPs by a trained CP, their frequency and associated comorbidities	67 CKD patients	70	The CP interviewed patients and established a pharmacological profile, checked for drug–drug interactions, verified dose adaptation according to the last renal function tests and searched for self-medication and its potential nephrotoxicity. The pharmaceutical proposals were validated with the consulting nephrologist so as to optimise therapy during the following renal consultation	Not reported
Belaiche et al. (2012b) France [28]	Retrospective uncontrolled study (15 months)	Nephrology clinics of a university hospital	To assess the impact of clinical pharmacy services in outpatient nephrology clinics	42 CKD patients	64.9 (2.2)	Identification of DRPs by CP and documentation of recommendations	Not reported
Dashti-Khavidaki et al. (2012) Iran [23]	Prospective uncontrolled study (6 months)	Haemodialysis treatment centre of a teaching hospital	To assess the impact of clinical pharmacy services on the management of secondary complications in patients who were on HD, including bone metabolism disorders, anaemia and dyslipidaemia	86 HD	NR	CP reviewed patients medications and proposed modification according to laboratory data results to treating physicians	Serum Calcium was increased in hypocalcaemia patients and decreased in hypercalcaemia patients until it reached the optimal range in both groups A decline in serum Phosphate level was noted in hyperphosphataemia patients There was an increase and decrease in serum iPTH in suboptimal and supraoptimal range patients, respectively 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
Geerts et al. (2012) Netherlands [33]	Prospective uncontrolled study (unclear)	Primary health care	To assess the therapeutic advice formulated by pharmacists with help of a pharmacy medication alert system based on the renal function of patients aged ≥ 70 years with diabetes or cardiovascular disease	650 CKD patients	81 (6.7)	The pharmacists used a pharmacy medication alert system to assess the medication in relation to the reported eGFR and provided an alert for target drugs according to the Dutch guidelines for drug administration in reduced renal function	Not reported
Abu Ruz et al. (2013) Jordan [37]	Prospective uncontrolled study (3 months)	Nephrology ward of a general teaching hospital	To implement and evaluate the impact of pharmaceutical care service for hospitalised CKD patients in Jordan	130 CKD patients	56.3 (17.8)	The pharmacist Identified TRPs and interventions were discussed during ward rounds. Patients education and interview to improve patient adherence	17% of all TRPs were resolved, 5.5%were improved, and 37.4%were prevented through the clinical pharmacist interventions
Chen (2013) Singapore [25]	Prospective uncontrolled study (5 months)	Haemodialysis centre of a general hospital	To evaluate the prevalence of DRPs identified and the types of interventions made by MMS pharmacists	30 HD	62.3 (10.0)	Patients requested to bring their medication and see the pharmacist before the appointment with their physician. Pharmacist reviewed patients records, counsel the patients, identified and reported DRPs	Not reported
Jiang et al. (2013) Japan [38]	Prospective uncontrolled study (24 months)	Medical and surgical ICU of a university-affiliated hospital	To evaluate the benefits that may result from involving pharmacists in the care of septic patients receiving CRRT	144 Pre-intervention (71 patients) Post-intervention (73 patients) CRRT	Pre-intervention: 62.3 (17.0) Post-intervention: 57.9 (15.4)	Pharmacists completed 1 month of training before the study was started During the intervention period, the pharmacists assessed septic patients receiving CRRT daily and adjusted the dosage of antimicrobial drugs when needed. Recommendations were made to physicians and nurses at that time. All pharmacist recommendations were verbal and recorded on a specially designed pharmacist intervention form	Dosing adjustments were related to a reduced length of ICU stay from 10.7 ± 11.1 days to 7.7 ± 8.3 days (p = 0.037) in the intervention group, and to cost savings of 3525 USD (13,463 ± 12,045 vs. 9938 ± 8811, p = 0.038) per septic patient receiving CRRT in the ICU Suspected antimicrobial adverse drug events in the intervention group were significantly fewer than in the pre-intervention group (19 events vs. 8 events, p = 0.048) Dosing error events were significantly fewer in the post-intervention phase than in the pre-intervention phase (54 in 73 patients vs. 194 in 71 patients, p < 0.001)
Mousavi et al. (2013) Iran [22]	Retrospective/Prospective uncontrolled study (12 months)	University hospital based nephrology wards	To evaluate appropriateness of acid suppression therapy in kidney disease patients and to assess the role of clinical pharmacists to decrease inappropriate SUP prescribing and related costs for these patients	Pre-test phase (375 patients) Post-test phase (236 patients)	Pre-test phase 51.2 (18.3) Post-test phase 50.2 (18.8)	Pre-intervention phase: patient chart review by CP, develop SUP protocol, and provide educational sessions to doctors on SUP Post-intervention phase: Clinical pharmacists accompanied physicians on the ward rounds and advised on starting or stopping SUP	Not reported
Rani et al. (2013) India [50]	Prospective uncontrolled study (3 months)	Dialysis unit of a multispecialty university hospital	To assess the medication knowledge of CKD patients undergoing HD, to assess the effect of a CP provided continuous patient education in improving medication adherence and to evaluate the association between medication knowledge and medication adherence behaviour in HD patients	85 HD patients	50.52 (13.28)	Patient counselling and education (verbally and written). Patient interview to assess medication knowledge using MKAQ. To assess medication adherence pattern using BMQ	Not reported
Aberger et al. (2014) USA [41]	Prospective uncontrolled study (4 weeks)	Transplant clinic of a large urban hospital	To describes a telehealth system approach and preliminary results for the management of BP in renal transplant recipients and to enhance patient engagement and improve adherence to medications via a collaborative care, pharmacist-based, MTM program	66 Tx patietns	54	Telehealth system encompassing: home electronic BP monitoring designed to assess the efficacy of antihypertensive therapy. The pharmacist communicates BP reading data and dose modifications to the physician	Statistically significant reductions in average systolic and diastolic BP of 6.0 mm Hg and 3.0 mm Hg, respectively, at 30 days after enrolment (p < 0.01)
Arrabal-Durán et al. (2014) Spain [26]	Prospective uncontrolled study (10 months)	Hospital wards and emergency department of a general university hospital	To assess the characteristics of pharmaceutical interventions concerning the dose adjustment of these drugs in patients with CRF who are admitted into hospital	181 CKD patients	77.6 (12.5)	Medical history of each patient was reviewed by CP, recommendations for an adjustment were put in writing for the doctors	Not reported
Barnes et al. (2014) USA [27]	Retrospective uncontrolled study (12 months)	Primary care setting, Patient -Centred Medical Home associated with a major, academic health system	To increase the identification of CKD as a medical problem, increase the use of aspirin and ACEIs/ARBs in patients with CKD, and ensure that all medications prescribed to patients with CKD were dosed appropriately based on CG calculated CrCl	146 CKD patients	71.6 (12.2)	Review EMRs to identify CKD patients, review medication list, estimate CrCl and recommendations reporting to the physicians	Not reported
Gheewala et al. (2014) Australia [19]	Retrospective uncontrolled study (12 months)	Aged care facilities	To investigate the number and nature of DRPs identified and recommendations made by pharmacists in residents of aged care facilities To determine the extent of inappropriate prescribing of renally cleared medications in residents with CKD	847 CKD patients	84.9 (8.8)	DRPs identified, and recommendations made to resolve those DRPs by CP	Not reported
Holm et al. (2015) Norway [24]	Prospective uncontrolled study (6 months)	Internal medicine department of a general hospital	To describe the use of renal risk drugs in a population of patients with RI in an internal medicine department and investigate possible risk factors for such DRPs	79 CKD patients	78.7 (10.2)	The CP reviewed the patients’ drug regimen to classify DRPs related to renal function. DRPs identified were discussed with the physician	There was a significant correlation between the patients’ GFR and the number of DRPs, with an increasing number of DRPs with deteriorating renal function (p = 0.001, r = 0.371)
Pourrat et al. (2015) France [16]	Prospective uncontrolled study (7 months)	Community pharmacies	(1) To evaluate the ability of community pharmacists to identify drug related problems (DRP) in patients at risk for or suffering from renal impairment. (2) To evaluate the proportions of recommendations by CPs that lead to a modification by GP	177 CKD patients	78.1	The community pharmacist filled an electronic form for each prescription and verify whether the drug had to be adapted to renal function or was contraindicated Potential modification was proposed to the GP	Not reported
Venkateswararao et al. (2015) India [49]	Prospective uncontrolled study (6 months)	Dialysis unit of a teaching hospital	To evaluate the patient perception and degree of adherence to various treatment modalities (medication use, dialysis, life style modifications) by renal failure patients on HD To assess the effect of pharmacist’s interventions towards improving the adherence among the study population	58 HD patients	46.7 (13.3)	Patient counselling once in 2 weeks (total 3 sessions) was provided. Printed information leaflets and written information on dialysis note in regional language were provided to the patients. Adherence pattern before and after patient educational intervention was assessed	Not reported
Patricia and Foote (2016) USA [46]	Prospective uncontrolled study (17 months)	Regional dialysis units	To identify the extent and type of medication discrepancies and MRPs experienced by dialysis patients during pharmacist-initiated medication reviews and determine if the resulting recommendations made by the pharmacy team to the patient’s provider were accepted	90 HD	NR	Patients requested to bring their medication to dialysis unit and medication reconciliation conducted by the pharmacy team	Not reported
Ramadaniati et al. (2016) Indonesia [31]	Prospective uncontrolled study (3 months)	Medical wards and an ICCU in a major teaching hospital	To identify and evaluate drug-related problems (DRPs) in patients with CKD	105 CKD	NR	Identification of DRPs through the direct patient interview, discussion with nurses and assessment of patients’ medication charts and medical records	Not reported
Adibe et al. (2017) Nigeria [42]	Prospective uncontrolled study (5 months)	Nephrology units of three tertiary hospitals	To determine the prevalence of DTPs, identify the types of DTPs, and assess the outcomes of DTP interventions among renal patients receiving care in three Nigerian tertiary hospitals	287 patients with renal illnesses	72.34 (7.56)	Identify and report DRPs. Patient education and counselling	Not reported
Alshamrani et al. (2018) Saudi Arabia [59]	Retrospective uncontrolled study (3 months)	Outpatient haemodialysis unit of a tertiary hospital	To determine the prevalence of polypharmacy and the Medication Related Problems in haemodialysis patients	83 HD patients	Median age 63, IQR (49–1)	The pharmacy resident reviewed electronic medical records and analysed each medication regimen for eligible patients to identify MRPs	Not reported
Chandrasekhar et al. (2018) India [60]	Prospective interventional study (12 months)	Outpatient nephrology department	To evaluate medication adherence behaviour of patients using questionnaire and enhance adherence by various cost effective interventions which have greater effect on the health of patients with CKD	163 CKD patients	–	Patient counselling by pharmacist and patient information leaflet was carried out using a proper management plan and with the help of physician and feedback information was collected	Not reported
Imamura et al. (2018) Japan [61]	Retrospective uncontrolled study (unclear)	Hospital	To determine whether multidisciplinary care could help prevent worsening renal function associated with CKD	150 CKD patients	72.3 (10.5)	The multidisciplinary care was provided by a team of nephrologists, diabetologist, nurses, diabetes educator, dietitians and pharmacists	The eGFR significantly improved between before and after multidisciplinary care from − 5.46 to − 0.56 mL/min/1.73 m2/year, respectively Values for uric acid, LDL, and HbA1c were significantly reduced among patients with improved eGFR

ACEi angiotensin converting enzyme inhibitors, ACR albumin:creatinine ratio, ARBs angiotensin receptor blockers, BMQ Brief medication questionnaire, BP blood pressure, CrCl creatinine clearance, CG Cockcroft-Gault, CKD chronic kidney disease, CP clinical pharmacist, CRF chronic renal failure, CRRT Continuous renal replacement therapy, DRPs drug related problems, eGFR estimated glomerular filtration rate, EMRs electronic medical records, FBC full blood count, GFR glomerular filtration rate, GP general practitioner, HbA1c glycosylated haemoglobin, HD haemodialysis, ICCU intensive critical care unit, ICU intensive care unit, iPTH intact parathyroid hormone, IQR interquartile range, MKAQ Medication knowledge assessment questionnaire, MMS medication management service, MRPs medication related problems, MTM medication therapy management, NR not reported, RI renal impairment, SUP stress ulcer prophylaxis, TRPs therapy related problems, Tx transplantation