Effects of Pharmaceutical Care on Delaying Progression of Renal Insufficiency in Chronic Kidney Disease with Type 2 Diabetes Patients
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Introduction: Diabetes is the common main cause of end-stage renal disease. Providing the pharmaceutical care program in patients with early-stage chronic kidney disease (CKD) can delay the progression of CKD. The present study aimed to determine the effect of pharmaceutical care on delaying progression of renal insufficiency among CKD with Type 2 diabetes patients. Methods: An experimental study was performed in patients with CKD stage 1 - 4 concomitant with Type 2 diabetes at Laem Chabang Hospital from April to December, 2016. Eligible patients (n = 168) were randomly allocated either to structured care (SC) group (n = 83) or the usual care (UC) group (n = 85). In the SC group, the pharmaceutical care program was provided to the patients by a research pharmacist who worked with a multidisciplinary team for screening patients with risk factors, evaluating the laboratory values, doctor prescribing and medication dosage adjustment, drug related problem (DRP) identifying and DRP solving also providing education on delaying progression of CKD for the patients. In the UC group, the pharmaceutical care program was not applied to the patients. Both groups were followed up in 0, 4 and 8 months. Results: At the end of the study, the decrement in eGFR of the patients in the SC group as compared with baseline was not statistically significantly different from the UC group (1.10 and 2.38 mL/min/1.732, respectively; p = 0.701) When considering each stage of CKD, the decrement in eGFR of patients with CKD stages 2 and 3a in the SC group was statistically significantly lower than that in UC group (p = 0.012 and p = 0.045, respectively). Albumin to creatinine ratio (ACR) values in both SC and UC groups were not statistically significantly (p = 0.215). The results of the pharmaceutical care process in the SC group showed greater numbers of DRPs found and solved (63.81, 38.13 percent respectively), and patients with CKD stage 1-4 had better control of their risk factors Conclusion: The pharmaceutical care program with the multidisciplinary team has a tendency to delay progression of renal insufficiency in patients with CKD concomitant with Type 2 diabetes.
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