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Clinical pharmacy practice in the care of chronic kidney disease patients: a systematic review.

Al Raiisi, Fatma; Stewart, Derek; Fernandez-Llimos, Fernando; Salgado, Teresa M.; Mohamed, Moustafa Fahmy; Cunningham, Scott


Fatma Al Raiisi

Derek Stewart

Fernando Fernandez-Llimos

Teresa M. Salgado

Moustafa Fahmy Mohamed


Background: Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients. Given recent practice developments (e.g. polypharmacy reviews and pharmacist prescribing) there is a need to provide a current synthesis of the evidence base for characteristics and outcomes of clinical pharmacy practice in chronic kidney disease (CKD) patients. Aim of the review: To critically appraise, synthesise and present the available evidence of the characteristics (structures and processes) and outcomes of clinical pharmacy practice as part of the multidisciplinary care of patients with CKD. Method: PubMed, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus were searched for peer-reviewed papers using improved search strategy. Included studies were quality assessed using Downs and Black tool for controlled studies and the mixed methods appraisal tool for all controlled and non-controlled studies. Data were extracted and synthesised using a narrative approach. Screening, quality assessment and data extraction were performed by two independent researchers. Ethics approval was not required. Results: Forty-seven studies were identified from a variety of countries, with 31 based in a hospital setting. Controlled study designs were employed in 20, with only ten of these using randomisation. Resources available for service provision were poorly reported in all papers. Positive impact on clinical outcomes included significant improvement in parathyroid hormone, blood pressure, haemoglobin and creatinine clearance. Pharmacists identified 5302 drug related problems in 2933 patients and made 3160 recommendations with acceptance rates up to 95%. Impact on humanistic outcomes was shown through improvement in health related quality of life and patient satisfaction. Economic benefits arose from significant cost savings through pharmaceutical care provision. Conclusion: While there is some evidence of positive impact on clinical, humanistic and economic outcomes, this evidence is generally of low quality and insufficient volume. While the existing evidence is in favour of pharmacists’ involvement in the multidisciplinary team providing care to patients with CKD, more high-quality research is warranted.


AL RAIISI, F., STEWART, D., FERNANDEZ-LLIMOS, F., SALGADO, T., MOHAMED, M.F. and CUNNINGHAM, S. 2019. Clinical pharmacy practice in the care of chronic kidney disease patients: a systematic review. International journal of clinical pharmacy [online], 41(3), pages 630-666. Available from:

Journal Article Type Article
Acceptance Date Mar 27, 2019
Online Publication Date Apr 9, 2019
Publication Date Jun 30, 2019
Deposit Date Apr 15, 2019
Publicly Available Date Apr 23, 2019
Journal International journal of clinical pharmacy
Print ISSN 2210-7703
Electronic ISSN 2210-7711
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 41
Issue 3
Pages 630-666
Keywords Chronic kidney disease; Clinical pharmacy; Pharmacist; Systematic review
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