Current Status and Challenges of Chronic Kidney Disease Stickers

Abstract

Appropriate prescription review based on kidney function is essential to ensure safe and effective pharmacotherapy. As a simple tool to convey kidney function, the chronic kidney disease (CKD) sticker has been utilized in clinical practice. In a survey conducted by the CKD Sticker Promotion Working Group of the Japanese society of Nephrology and pharmacotherapy, CKD stickers were identified in 62 regions. The scale of implementation varied widely, ranging from prefecture-wide programs to initiatives at individual facilities. A variety of organizations—including local governments, medical associations, and pharmaceutical associations—were involved in their implementation, suggesting that CKD stickers serve not merely as a tool but as part of an organized program.

In many regions, the primary purpose of CKD stickers was to promote appropriate use of medications by pharmacists, but some areas also used them to facilitate information sharing with primary care physicians or to encourage behavioral changes in patients. The thresholds for estimated glomerular filtration rate (eGFR) at which the stickers were applied appeared to be set according to the objectives of each region, such as early intervention and efficient allocation of medical resources. Both phased replacement formats and versions requiring manual entry of eGFR values were observed. Physicians and pharmacists were the primary professionals responsible for applying the stickers, while in some areas, nurses, public health nurses, dentists, and local government staff were also involved. Certain regions limited sticker application to nephrologists or hospital pharmacists to ensure accuracy, while others later broadened the range of eligible professionals to promote wider adoption. From a design perspective, many regions customized the information displayed on the sticker according to the intended audience, and some even included direct messages to CKD patients.

Challenges identified included limited spread, leading to uneven application within regions, and the coexistence of multiple types of CKD stickers within the same or neighboring areas. Early-adopter regions reported an increase in prescription queries from pharmacist to physician prompted by CKD stickers and a decrease in hospitalizations due to drug-induced kidney injury. However, there have been no reports of hard endpoints, such as reductions in dialysis initiation or improvements in eGFR slope, indicating the need for future outcome-based studies.