Chronic kidney disease (CKD) is a health epidemic globally; it is becoming more and more common. It is common for people with CKD to also have Anemia. The treatment for the combination of the two is erythropoietin-stimulating agents (ESAs), which lowers the need for blood transfusions. Many health professionals believe that the treatment of anemia in patients with CKD influences the quality of life for the patients involved. It is believed that younger patients could potentially benefit from higher hemoglobin targets. However, higher targets may be harmful to older individuals due to cardiovascular risk factors. This study analyzes the benefits of achieving higher hemoglobin targets with ESA’s and how that effects the health-related quality of life.
They analyzed several previously conducted studies to determine if there has been a significant effect on the quality of life of these patients. They measured the follow-up scores of the health-related quality of life between 2 different time points during the hemoglobin studies. They ended up reviewing 17 studies that met their criteria; these studies included patients with CKD who were receiving dialysis and not receiving dialysis and the different levels of ESAs.
This study found that there were no statistically significant differences between lower and higher hemoglobin targets for health-related quality of life measurements. It shows that the use of ESAs to improve quality of life is not appropriate for all patients. This is a way to personalize medicine, but looking at each patient individually and assessing whether or not they would benefit from higher ESA levels and more hemoglobin targets. What are some other ways personalizing medication is being implemented into health care?
Collister, David. “The Effect of Erythropoietin-Stimulating Agents on Health-Related Quality of Life in Anemia of Chronic Kidney Disease.” Ann Intern Med 2016: n. pag. http://annals.org/article.aspx?articleid=2491918
While non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are very easy to purchase (in grocery stores and gas stations), they are one of the most common medications improperly prescribed, especially to older adults. If these are used at a high dose regularly and combined with the wrong medications, it can lead to acute kidney injury (AKI). NSAIDs inhibit the cyclooxygenase enzyme, preventing prostaglandin production. Prostaglandins help to autoregulate the dilation of arterioles in the kidney, controlling the amount of blood filtered. If AKI goes untreated long enough, self-prescribing NSAIDs can even lead to chronic kidney disease (CKD). Luckily, there are strategies that pharmacists can use to prevent patients from overusing NSAIDs at home and prevent these adverse effects.
Pharmacists can use bright stickers or post-it notes on the prescriptions of those who need medication counseling due to a high risk for AKI or CKD (patients with hypertension or diabetes). This will help the staff to remember to discuss the patient’s personal pain management system during consultations, blood pressure screenings, or when handing out the prescription. If the patient is in a rush, a handout could also be placed in with the prescription or on a pamphlet table so that the information is still available. They can also help to counsel on when to use ice or heat on a musculoskeletal issue, rather than taking an NSAID to relieve pain. This gives the patient other ways to manage their pain without taking an NSAID too frequently.
Acetaminophen could also be recommended as a pain reliever for those who are at high risk for AKI or CKD, as it is metabolized in the liver more than the kidney and is rarely seen to damage the kidney. However, this will then require that the pharmacist counsel on the maximum daily dose for acetaminophen in combination with other acetaminophen-containing medications the patient may have. This would be an optimal alternative if the patient is insistent on taking a pill for their pain, as long as the proper counseling regarding acetaminophen can be delivered.
I felt that this article had a lot of good options for educating patients with increased risk for kidney injuries against NSAID use. The repetition of seeing a helpful handout with the patient’s prescription would demonstrate the importance of the issue. The handout could serve as an additional reminder each time the patient has their prescription filled to steer clear of NSAIDs and use another pain-relieving method. This article also ties in nicely with what we are currently learning in anatomy and physiology and helped my understanding of kidney damage via non-steroidal anti-inflammatory drugs.
Pai, Amy B. “Keeping kidneys safe: The pharmacists’ role in NSAID avoidance in high-risk patients.” Journal of the American Pharmacists Association. 55.1 (2015) e15-e25. Web. 14 February 2016.