Kidney Week

Abstract: FR-PO1105

CKD Care: Evaluating the Role of Clinical Pharmacists

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Yamada, Masaaki, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Masaaki Yamada, MD

• Shi, Qianyi, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Qianyi Shi, PhD

• Lund, Brian C., Iowa City VA Medical Center, Iowa City, Iowa, United States

Brian C. Lund, PharmD

• Good, Mary K., Iowa City VA Medical Center, Iowa City, Iowa, United States

Mary K. Good, PhD

• Griffin, Benjamin R., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Benjamin R. Griffin, MD

• Swee, Melissa L., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Melissa L. Swee, MD, MS, FASN

• Akbari, Sadaf, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Sadaf Akbari, MD

• Kennelty, Korey, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Korey Kennelty, PharmD, PhD

• Faro, Elissa Z., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Elissa Z. Faro, PhD

• Sarrazin, Mary Vaughan, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Mary Vaughan Sarrazin, PhD

• Jalal, Diana I., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Diana I. Jalal, MD

Background

Clinical pharmacists are proven to lower cardiovascular (CV) risks in chronic disease management. Chronic kidney disease (CKD) increases CV events, yet studies on clinical pharmacist-driven CKD care remain scarce. We evaluated the pharmacist utilization in CKD within the Veterans Health Administration–known for its robust clinical pharmacist workforce.

Methods

We conducted a retrospective cohort study of Veterans with CKD. CKD was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min (measured twice, ≥90 days apart) during 2018 to 2019. Pharmacist users were individuals who had at least 1 clinic visit with a clinical pharmacist. Logistic regression analysis was used to identify factors associated with pharmacist use.

Results

Our cohort (732,003 Veterans with CKD) was predominantly White (72%) and male (96%), with mean age=75 years (yrs) and mean eGFR=46 mL/min; 37% lived in rural areas. 22% were identified as pharmacist users. Compared to pharmacist non-users, pharmacist users were younger (70 vs. 75 years), less likely to live in rural areas (35% vs. 37%) and had a higher prevalence of diabetes mellitus (74% vs. 46%). Logistic regression analysis indicated lower pharmacist utilization among Veterans aged ≥70 yrs (odds ratio [OR] 0.82 for age 70-79 yrs and 0.63 for age ≥80 yrs, p <0.01), particularly in rural areas (p for interaction, <0.05) as shown in Figure. Rurality was associated with underutilization of pharmacist-led care (OR, 0.92, p <0.001). Clinical pharmacist utilization did not differ across varied CKD stages (p >0.05).

Conclusion

Approximately 1 in 5 Veterans with CKD utilize clinical pharmacist care. Older age and rural residence significantly associate with underutilization of pharmacists in CKD care.

Funding

• Veterans Affairs Support