Renal clinical pharmacy services and outcomes for patients on dialysis: a scoping review

Background

People with end-stage kidney disease receiving dialysis in any form commonly experience symptoms associated with their reduced renal function and dialysis treatment, often requiring complex medication therapy to manage. Pharmacists are ideally placed as medicines experts to contribute alongside the multidisciplinary team in optimising patient care. However, specialty dialysis clinical pharmacist roles are beginning to emerge, and few studies have been conducted evaluating the impact of clinical pharmacists in dialysis services.

Aim

This scoping review aimed to identify and evaluate clinical pharmacy services implemented, and outcomes measured, for patients receiving haemodialysis or peritoneal dialysis in the hospital or home setting.

Design

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies published in English, with participants aged over 18 years receiving any chronic dialysis and involving clinical pharmacist services were included. Studies were excluded if they included only medication supply services or only included patients receiving continuous renal replacement therapy.

Results

Thirty-five studies, published 1997–2024, detailing 17 unique pharmacist interventions for patients receiving dialysis were identified and measured using 17 different outcomes. In the 25 studies, the most common pharmacist interventions included specialist pharmacist medication review (n = 29), pharmacist inclusion in the multidisciplinary team (n = 22), extended pharmacist consultation (n = 20), and targeted adherence counselling (n = 18). The outcomes measured were categorised into three broad themes: therapy-effectiveness, patient-centred, and health-system measures.

Conclusion

The interventions detailed in the included studies highlight an opportunity to extend the scope of pharmacist activities in providing dialysis services in Australia. This expansion would be in line with the ongoing reviews of scope of practice for health professionals and the broader trend of expanding the clinical pharmacist's role. The variability of detail provided in the studies limits transparency and transferability to different dialysis contexts and may impact the achievement of the outcomes described, but further inquiry is warranted.