Medication switching based on patient preferences is expected to improve medication palatability and adherence. This study aimed to evaluate the impact of phosphate binder switching, based on the preferences of patients undergoing HD through collaboration between community pharmacists and physicians, on medication palatability and adherence.

Initially, 50 patients undergoing HD treated with phosphate binders were surveyed regarding palatability using a visual analog scale (VAS). Nine (18%) patients reported difficulty taking medication (VAS score ≤40), and five of eighteen patients with a VAS score ≤50 requested a change in phosphate binders.

Subsequently, phosphate binders were switched based on preferences in seven patients undergoing HD (eight cases), following a phosphate binder switching protocol agreed upon in advance between the community pharmacy and the clinic. Patients were interviewed regarding their willingness to take the phosphate binder-based medication and its palatability using the Numerical Rating Scale (NRS), and their serum phosphate levels were assessed at the community pharmacy before and after the switch. The NRS scores for phosphate binder palatability and medication adherence changed from (median [range]) 5 [2–10] to 7.5 [5–10] (p=0.031) and from 2 [0–5] to 8 [4–10] (p=0.031), respectively, after switching. However, no significant changes in medication adherence or serum phosphate levels were observed in the overall patients. The two patients who were non-adherent to binders before the switch showed improved medication adherence.

In conclusion, this study suggests that switching phosphate binders based on the preferences of patients undergoing HD through collaboration between community pharmacists and physicians can improve medication palatability and adherence. This approach could be particularly effective for patients who were initially not adherent to their phosphate binders.

Hypoxia-inducible factor-proline hydroxylase inhibitors（“HIF-PH inhibitors”）became available for treating renal anemia starting in November 2019. In response, the Japanese Society of Nephrology issued a “Recommendation on the Proper Use of HIF-PH Inhibitors” providing guidelines to ensure their appropriate use. The volume of prescriptions from departments outside nephrology is increasing owing to the convenience of oral drugs. However, there have been scattered cases where prior examinations based on the issued recommendations were not conducted. This study assessed patients who received HIF-PH inhibitors at Toyota Kai Hospital（Kariya Toyota General Hospital, Kariya Toyota Higashi Hospital, Takahama Toyota Hospital）over 36 months from November 1, 2019, to October 31, 2022. The evaluation focused on the proper use of HIF-PH inhibitors through a retrospective chart review, examining the performance rates of various tests conducted pre- and post-HIF-PH introduction, and follow-up status after introduction.

The results indicated that iron kinetics assessments were significantly more frequently conducted in the nephrology department（85.7％）compared to other departments（60％）at the introduction of HIF-PH inhibitors. Similarly, the frequency remained significantly higher in the nephrology department（68.1％）than in other departments（20％）after introduction. While nephrology departments more frequently performed follow-ups for iron management and iron adjustment, the rates of ophthalmology visits and Hb measurements after introduction were low and inadequate, regardless of department.

These results indicate a need to establish a support system for pharmacists to promote the appropriate use of HIF-PH inhibitors.

We encountered a case in which acetazolamide (AZ), a renal excretory drug, tablets were set at a dose above the typical therapeutic range for the treatment of glaucoma in a hemodialysis (HD) patient, and blood levels and side effects were observed.

A woman in her 50s was undergoing HD and treated for right-angle-closure glaucoma secondary to diabetic retinopathy at an ophthalmology clinic. Multiple eye drops and AZ tablets were used to treat glaucoma, and AZ tablets of 125 mg thrice weekly resulted in a blood concentration of 14.3 µg/mL, which is within the therapeutic range (5–15 µg/mL). However, the ophthalmologist highlighted the elevated intraocular pressure to the attending dialysis physician and suggested increasing the AZ dose until glaucoma surgery was performed. The pharmacist explained the need to monitor for side effects, such as central nervous system (CNS) symptoms, hemopenia, and electrolyte abnormalities, which may occur because of increased blood AZ concentration associated with the increased dose, and the need to monitor blood AZ concentration, suggesting to increase the dose to 125 mg five times weekly. After increasing the dose, blood levels measured once a month remained above the therapeutic range at 21.2 μg/mL, 21.6 μg/mL, and 17.5 μg/mL, and increased intraocular pressure was suppressed. Subsequently, glaucoma surgery was performed and AZ tablets were discontinued because intraocular pressure improved. During the AZ dose escalation period, no hemopenia, electrolyte abnormalities, or CNS symptoms, such as convulsions and mental confusion, were observed.

Although the efficacy of high AZ concentrations in the treatment of glaucoma is unclear, this case shows that treatment could have been continued with the general dose regimen of AZ for HD patients and a theoretical dosing plan and observation of safety in collaboration with the ophthalmologist.