Investigating the Role of Pharmacists in the Management of Chronic Kidney Disease

Chronic kidney disease (CKD) is a progressive condition characterised by a gradual loss in function and/or structure of the kidneys over time. With an estimated global prevalence of 9%, CKD is associated with reduced quality of life, high morbidity and mortality, in which those with CKD are five to ten times more likely to die prematurely than progressing to end-stage kidney disease. Pharmacists are well-positioned with their clinical knowledge in pharmacotherapy to manage people with CKD, where they deliver various interventions, such as managing cardiovascular risk factors, dose adjustment, and patient education.The main aim of this thesis was to identify clinical opportunities and supporting evidence for pharmacist interventions in CKD. An epidemiological analysis of a cross-sectional study conducted in a diverse CKD population in England sought to establish medication prescribing patterns and polypharmacy prevalence. The prevalence of polypharmacy and inappropriate prescribing was high in people with CKD, where factors such as age, CKD type (worsening CKD and/or being a KTR), and number of comorbidities increased the odds of having polypharmacy.A systematic review and meta-analysis of randomised controlled trials was conducted and found pharmacist interventions in people with CKD have a mixed effect on clinical, economic, and humanistic outcomes. Improvements were reported in outcomes such as systolic blood pressure and haemoglobin levels, but not in other outcomes such as diastolic blood pressure and creatinine.Finally, the plethora of outcomes from the review resulted in the development of a core outcome set (COS) in nephrology for pharmacist research studies via an e-Delphi consensus study. This is the first COS in nephrology that is intervention-specific and reflects outcomes that were of importance to various stakeholder groups and will help reduce research waste.