Episode 46: Safe Drug Therapy in Chronic Kidney Disease
January 8, 2016
In this episode Craig Curtis talks about the role of pharmacists in Alberta in the development and use of the CKD (Chronic Kidney Disease) pathway. He highlights the importance of building an evidence-based pathway that includes international recommendations easily accessible to family physicians and pharmacists. Craig also describes the prevalence of kidney disease in Canada and the two most common causes of kidney disease in adults. He suggests some steps to take to prevent the loss of kidney function or to slow down the progression of the disease. In particular Craig talks about the “treat-and-forget” approach, a KDIGO (Kidney Disease Improving Global Outcomes) recommendation that suggests a safe and effective dose of statin for patients with CKD. He explains how inappropriate drug dosing occurs frequently causing many preventable adverse drug events.
Some medications require renal dose adjustment especially with the GFR falls below 30 mL/min. Craig encourages family physicians and pharmacists to make use of the CKD pathway and find the recommended doses for patients with CKD, but he also advices a rational assessment of each potential medication before any prescription is given to a patient with CKD. Moreover, Craig lists common medications that can worsen kidney function and explains how each situation requires an individualized assessment and a risk-versus-benefit approach to determine the course of action. Finally, Craig mentions other important features and resources of the CKD Clinical Pathway, like the information on classification of CKD, prognosis and frequency of testing, a Framingham risk calculator, management of elevated serum potassium and clinical practice guidelines used in developing the CKD Clinical Pathway. After listening to this podcast the listeners will be able to recognize the primary interventions for managing chronic kidney disease (CKD) in adults:
- Prevent progression: ACEi/ARB, DM
- Reduce cardiovascular (CV) risk: statin, antiplatelet
- Renal dose adjustments
- Avoid nephrotoxic medication
Craig Curtis, Clinical Pharmacist Alberta Health Services Nephrology, Calgary. Craig is a pharmacist with Alberta Health Services, currently working in Adult Ambulatory Services – Calgary Zone, with the Chronic Kidney Disease Clinic, the Peritoneal Dialysis Clinic and the Solid Organ Transplant Clinic. He is interested in the areas of medication reconciliation, nephrology, cardiology, transplant and precepting. Craig received his Additional Prescribing Authorization in 2013 and thoroughly enjoys precepting pharmacy students, pharmacy residents and PharmD candidates. He has also been involved in pharmacy professional practice research and helped develop the CKD Pathway. When Craig is not practicing pharmacy, you can find him hunting and fishing, and enjoying time in the great outdoors exploring the landscapes of Alberta with his wife and 2 dogs.
The Chronic Kidney Disease Pathway: www.ckdpathway.ca