EVALUATING THE IMPACT OF CLINICAL PHARMACISTS ON MEDICATION RECONCILIATION AND QUALITY OF LIFE IN CKD PATIENTS: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Abstract

Context: Chronic kidney disease (CKD) is associated with high medication burden, renal dose-adjustment requirements, drug-related problems and reduced quality of life. Pharmacist-led medication reconciliation may identify discrepancies and support safer nephrology care. Aim: To evaluate the role of pharmacists in identifying medication discrepancies and to examine the relationship between medication burden, adherence and quality of life among CKD patients. Settings and Design: A cross-sectional observational was prepared for adult CKD stage 3-5 patients in a secondary care hospital setting. 106 patients were enrolled in this study. Materials and Methods: Eligible patients were adults aged 18 years or above with CKD stage 3-5 receiving at least two chronic medicines. Medication history, current prescription, clinical variables, CKD stage, dialysis status, comorbidities, medication discrepancies, KDQOL-36 domain scores and MMAS-based adherence categories were documented. Medication discrepancies were classified as omission, commission, duplication, dose error, renal dose issue, drug-drug interaction, documentation error and adverse drug reaction. Statistical Analysis: Descriptive statistics, chi-square tests, Welch t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used. The chart was rechecked using Python 3.11 with SciPy and stats models. Results: The dataset included 106 patients; mean age was 56.6 +/- 10.1 years. Stage 5 CKD was present in 43 (40.6%) patients. Polypharmacy, defined as five or more medicines, was observed in 90 (84.9%). At least one discrepancy was present in 83 (78.3%). CKD stage was significantly associated with discrepancy presence (chi-square=28.69, p<0.001), and medication burden was associated with adherence category (chi-square=65.73, p<0.001). Mean overall quality-of-life score was lower among patients with discrepancies than among those without discrepancies (48.8 +/- 11.4 vs 62.4 +/- 9.2; t=5.91, p<0.001). Conclusion: This study concludes that pharmacist-led medication reconciliation is clinically relevant in high-burden CKD care.