Optimizing Medication Safety for Patients with ESKD Through Point-of-Verification Clinical Evaluations

Background: Patients with ESKD face a high medication burden and are at increased risk for medication-related problems (MRPs). Traditional outpatient pharmacy models often lack the clinical oversight needed to address these risks. An integrated renal mail-order pharmacy implemented a point-of-verification process using a clinical algorithm to identify medications requiring renal dose adjustment (RDA) or considered potentially inappropriate (PI), triggering pharmacist-led clinical medication evaluations (CME). This study evaluated the effectiveness of CME in identifying and resolving MRPs. Methods: This retrospective analysis included ESKD patients enrolled in pharmacy services from 2/13/23 to 2/13/25. Medications flagged for RDA or PI were isolated at verification for pharmacist CME. Pharmacists conducted patient-specific reviews, intervened on MRPs, and communicated recommendations to prescribers. Intervention acceptance rates, time to resolution, and most frequently reviewed medications were tracked using descriptive statistics. Results: Among 5,827 patients, 11,390 prescriptions underwent point-of-verification CME. The study population was predominantly male (52.4%), white (48.2%), undergoing in-center hemodialysis (68%) and covered by managed Medicare (48.9%). Interventions were required for 3,271 prescriptions, primarily for RDA (n=2,446). The top 10 medications requiring intervention are included in Table 1. The overall intervention acceptance rate was 69.4%, with an average resolution time of 3 business days. Conclusion: Point-of-verification CME within an integrated renal mail-order pharmacy effectively identified and resolved MRPs in patients with ESKD. This model demonstrates a scalable approach to improving medication safety through pharmacist-led interventions. Top 10 Medications - Drug Total % of Total Recommendations 1 Rosuvastatin 411 15.0% 2 Famotidine 384 14.0% 3 Apixaban 186 6.8% 4 Cetirizine 165 6.0% 5 Loratadine 115 4.2% 6 Chlorthalidone 96 3.5% 7 Spironolactone 89 3.3% 8 Colchicine 87 3.2% 9 Hydrochlorothiazide 84 3.1% 10 Bupropion 71 2.6%