A Collaborative Approach: Pharmacist-Led CKD Clinic in the Primary Care Setting

Background: Chronic Kidney Disease (CKD) affects a growing number of US adults every year, with many unaware of their condition. To address this, our ambulatory care pharmacy team has initiated a pharmacist-led CKD clinic in the primary care setting. We aim to identify and provide free Telepharmacy services, treatment, and monitoring for at least 100 patients in the early stages of CKD within our internal medicine practice over the course of a year and measure the impact of our services. Methods: Patients were selected for pharmacist intervention based on specific criteria, including diagnoses of diabetes, hypertension, and/or CKD, and GFR <90 ml/min and/or urine ACR >30 mg/mmol. Initially, 124 patients were identified candidates for the pilot program, and as of May 2024, 108 patients are participating. Among these patients, 100 have diabetes and 31 have a urine ACR >30 mg/mmol. After identification, patients had a telepharmacy visit with a pharmacist, who completed a medication reconciliation, reviewed lab results, initiated appropriate medications, and provided instructions for lab tests and follow-up visits. The pharmacy team tracked medication adherence, referrals to nephrology, and lab data. Results: Iinitial findings indicate the pharmacist-led program is impactful. Regarding medication adherence, all patients were prescribed an SGLT2i, and 75% were prescribed an ACE/ARB. Twelve patients were originally under the care of a nephrologist. No new referrals to nephrology were made. Additionally, 59% of patients experienced an increase or no change in their GFR. Conclusion: The pharmacist led team will continue to follow these patients through July 2024. To this point, the impact of a pharmacist-led CKD clinic has demonstrated increased compliance on medication access and adherence with 100% of patients being treated with an SGLT2i and 75% an ACE/ARB as appropriate. Additionally no new referrals were made to nephrology for these patients throughout the pilot program. And finally, 59% of patients to date have seen a plateau or increase in their GFR indicating preservation of kidney function.