Impact of Clinical Pharmacist Integration on Weight Management and Transplant Eligibility Among Patients With End‐Stage Kidney Disease With Obesity

ABSTRACT Background Obesity is a barrier to kidney transplantation in patients with end‐stage kidney disease (ESKD). Injectable incretin peptides (IIP) have transformed weight management; however, real‐world data in ESKD are limited. This study evaluated the impact of integrating a clinical pharmacist practitioner (CPP) into an interprofessional high body mass index (BMI) kidney transplant clinic on weight loss and transplant eligibility outcomes. Methods This single‐center, retrospective study included adults with ESKD and obesity‐prescribed IIP for transplant eligibility between June, 2022 and December, 2024. Cohort 1 included patients treated before CPP implementation; Cohort 2 included patients following implementation. The primary outcome was the percent change in body mass index (BMI) at 3, 6, and 12 months following IIP initiation. Secondary outcomes included changes in transplant eligibility status, IIP dose intensity, and predefined adverse events (AEs) at 12 months. Results Eighty‐four patients were included (Cohort 1: n = 28; Cohort 2: n = 56). Cohort 2 achieved greater BMI reductions at 3 (−2.0% vs. +1.45%), 6 (−3.3% vs. +1.16%), and 12 months (−8.0% vs. +2.8%; p < 0.01 for all). Among patients initially ineligible for kidney transplantation, 45% of patients in Cohort 2 became active on the transplant waitlist by 12 months compared with 11.5% in Cohort 1 ( p = 0.006). More patients in Cohort 2 reached high IIP dose intensity (48.2% vs. 3.6%, p < 0.001), without differences in AE. Conclusions IIP therapy appears safe and effective in ESKD. CPP integration was associated with greater weight loss, increased achievement of active transplant eligibility, and improved treatment optimization, highlighting its potential role in addressing obesity‐related barriers to transplantation.