Home » World Kidney Day 2024
In Ireland, one in seven people over the age of 50, which is over 200,000 people in that age group, have CKD. We know this from The Irish Longitudinal Study on Ageing (TILDA) data published in late 2023. It also informs us that in the over-50s age group, more than 740,000 people have hypertension and 180,000 people have diabetes — two major conditions that increase the risks of CKD and worsening of CKD. Lastly, it informs us that half of those with CKD have uncontrolled hypertension, which increases the risks of negative outcomes in terms of progression of CKD and cardiovascular disease.
The pharmacist, starting with the community pharmacist is a key figure in our collective efforts against CKD. Many people benefit from blood pressure (BP) screening in their local pharmacy. This provides an avenue for opportunistic pick-up of hypertension, which can be confirmed with further testing with their General Practitioner. Their GP may also carry out urine dipstick testing as it can lead to an opportunity to diagnose CKD in people who otherwise would have no symptoms and treat their risk factors for worsening CKD.
People with CKD, who may take advantage of BP monitoring at their pharmacy, benefit from discussing their ongoing BP results with their community pharmacists and advising them to check if their readings meet the BP targets advised by their doctors. Depending on their age, and type of kidney disease — if they have protein in their urine or not, people with CKD have different BP targets or goals, which their kidney doctor will have set and will work towards achieving with them. A community pharmacist can play a key role in helping to achieve this also.
The community pharmacist has a key role here, in ensuring their immunosuppression medicines are kept constant — with no change in brand or formulation without a review by the kidney transplant physician
There are more than 5,000 people in Ireland with end-stage kidney disease, and 2,700 people with a kidney transplant. This group of people are prescribed a large number of medicines, to both manage immunosuppression post-transplant alongside medicines to manage cardiovascular and diabetic complications. The community pharmacist has a key role here, in ensuring their immunosuppression medicines are kept constant — with no change in brand or formulation without a review by the kidney transplant physician. The community pharmacist also plays a great role in helping patients navigate the risk of interactions of new medicines (such as a short-term antibiotic for an unrelated issue given from another domain) with their immunosuppression medicines. This is an issue that weighs heavily on transplant patients and poses a great risk to their health, and the watchful eye of their community pharmacist is a key layer of protection for them.
People on dialysis, of whom there are more than 2,400 in Ireland, often need Hi Tech medicines which need special storage and frequent dose adjustments, such as erythropoietin used to treat anaemia associated with CKD, or agents to treat mineral bone disease due to CKD. They benefit greatly from the support and flexibility of their local pharmacist.
All the above groups of patients can have several transitions of care between the community setting, hospital admissions, dialysis units and outpatient appointments. They are a patient group that have a high number of medicines prescribed for them, many of which can interact with each other or require dose changes dependant on the patients’ renal function. This group really benefit from pharmacist input in any setting.
They benefit from the role of the hospital pharmacists while hospitalised. Patients with CKD, or those who have temporary worsening of kidney function acutely, AKI (acute kidney injury) or those who suffer from a combination (AKI on CKD), are at high risk of adverse drug effects due to their kidney function, yet they often need new medicines (at least temporarily) to treat the illness that has led to their admission, such as antimicrobials, anti-coagulants. The hospital pharmacist plays a key role in assessing drug-to-drug interactions, and helps to inform the risk-benefit ratio in dose adjustment for their level of kidney function.
Again, when the care of the patient transfers back to the community, the community pharmacist plays a key role in establishing the new medication regimen for patients safely, noting these may need to change in the short-term period after a hospitalisation.
Lastly, the role of the pharmacist in a regulatory role is important for patients with CKD. Ensuring that medicines that require adjustment for kidney function are labelled clearly as so in the summary of product characteristics, SPC for physicians to guide patients. Also, disseminating information about newly identified interactions or side effects affecting kidney patients is another key role. Finally, kidney patients benefit when they or people like them are included in clinical trials to treat conditions that affect them. It is important that those in regulatory roles, and all of us, continue to advocate for people with kidney disease not to be excluded from clinical trials, but for every effort to be made to include them safely.
The rising prevalence of CKD looms large, as we age as a population and as many of our risk factor conditions are poised for rising incidence. Yet, there are actions which we can use to support people with CKD or at risk of CKD.
The theme of World Kidney Day 2024 is “Kidney Health For All: Advancing equitable access to care and optimal medication practice”. The role of pharmacists is a very significant one in achieving this.
If a patient has diabetes, hypertension and/or cardiac disease, suggest screening for kidney disease and vice versa.
Check if a patient has a diagnosis of CKD and if they do, check the drug database for interactions.
Suggest agreeing blood pressure target with their GP. This is usually less than 140/90mmHg, but for some people is less than 130/80mmHg.
Suggest screening for diabetes and, if present, make sure patient knows target blood sugar range and monitor their HBA1c.
Suggest patient monitors their weight as increasing weight could be caused by the patient’s body retaining fluid.
Advise patients on a healthy lifestyle, referring to other partners as necessary.
Advise patients on ‘sick day rules’. Medications for which ‘sick day rules’ apply are SADMANS:
Dr Ayanfeoluwa Obilana
Consultant in Nephrology and
General Medicine, Mercy University Hospital, Cork
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