Kidney health and pharmacists can go hand in hand
Have you ever seen something so serendipitous that you wonder if divine intervention really does exist? Those moments you know deep down are too perfect for even the most astute strategies? We all know that March is Pharmacy Appreciation Month in Canada. But did you know it is also Kidney Health Month for Canada? With the vital role pharmacists have to play in kidney health and monitoring I’m at a loss to come up with a better match.
I’ll never forget the day I sat in pharmacy school learning about kidney health. We were to assess a patient’s medication list in the context of kidney disease. Directed to the Compendium of Therapeutic Choices’ chapter on Dosage Adjustment in Renal Impairment (1), step one was to look for medications that are nephrotoxic and remove them if possible. I remember scrolling through the pages alphabetically, and noting the drugs which were nephrotoxic. ASA, Celecoxib, Diclofenac, ibuprofen, naproxen. ...wait a minute!? Why am I just learning this now in my late 20s? Why is this not plastered all over the OTC aisles in pharmacies?
Not to be too cynical, but I suppose sales of Advil would take a sharp downturn if there were signs warning of the dangers all over the OTC aisles. Don’t fret, dear colleagues in community pharmacy. Short of going rogue and contributing to the economic destruction of your place of employment, here are some steps you can take to protect the kidneys in your community:
Keep a keen eye on the OTC analgesics aisle
As the keepers of the all-important OTC aisles, retail pharmacists can watch for recurrent OTC NSAID purchases and educate patients at the pharmacy checkout. We can also watch for long term NSAID prescriptions and counsel patients on alternatives. It is rarely appropriate to allow a naproxen prescription to leave the pharmacy without PRN included on the label.
Assess medication appropriateness and doses routinely
Make use of the section in your pharmacy software reserved for medical conditions and populate it with everything you can for a patient. If the patient has reduced kidney function, note that in this section along with an estimated GFR and a date. Routinely check to see whether their GFR has changed to determine if any changes to medications are needed. The system will flag drug-disease interactions on every dispense, so document your assessment of their medication list with a date so that you minimize the legwork your colleagues need to do when dispensing in the future.
Educate and discuss monitoring points with your highest risk patients
Without undertaking a PhD worthy program, you can educate patients by directing them to your province’s renal program website. BC Renal has an excellent website which includes a quiz to assess risk for kidney injury. You can also discuss monitoring points with your most at-risk individuals. Top picks for disease states could include those with diabetes, hypertension, benign prostatic hypertension, liver disease, lupus, or rheumatoid arthritis, and those who smoke. Monitoring should also be discussed with anyone who is on a nephrotoxic drug or those drugs that would constitute a triple whammy: an ACEi/ARB + a diuretic + an NSAID.
Monitoring points should include signs of deteriorating kidney function and signs of dehydration. Due to the higher risk of dehydration and hypovolemia, counselling patients to discuss a sick-day plan with their physician would be warranted as well.
References:
- McCormack, J., Carleton, Bruce., & Calissi, P. (2017). Appendix I: Dosage Adjustment in Renal Impairment. In B. CarlCompendium of Therapeutic Choices (Vol. 2017, pp. 1793–1821)., Canadian Pharmacist's Association.
https://bpac.org.nz/2018/triple-whammy.aspx
Kimberley Kallio is an engineer turned community pharmacist working out of Castlegar, BC. Since graduating from UBC in 2017, she has been drawn to preventative health, therapeutic nutrition and functional medicine. She is passionate about educating the public about these topics, whether at the pharmacy counter or on her blog at www.kalliofunctionalpharmacy.com.