Pharmacists involved in guidance for kidney disease treatment evaluate laboratory test results and medication history for both outpatients and inpatients in order to encourage more appropriate usage, change to other drugs when necessary, optimize prescriptions, or improve medication adherence. Here we retrospectively investigated the effects of interventions conducted by pharmacists in patients with pre-dialysis kidney disease.

　We reviewed medical records of patients referred to the nephrology department of Kouseikai Hospital from April 2015 to March 2019 and who had continued hospital follow-up visits for more than 3 months with at least two measurements of renal function assessment using estimated glomerular filtration rate (eGFR, mL/min/1.73 m²). We compared changes in renal function between 44 cases from April 2015 to March 2017 (non-pharmacist group) and 45 cases from April 2017 to March 2019 (pharmacist intervention group).

　Comparison of eGFR 3 months later showed no difference in improvement of renal function between the non-pharmacist group and the pharmacist intervention group, but eGFR in the non-pharmacist group tended to decrease. In patients with more than 10% improvement in eGFR, the pharmacist intervention group showed a significantly higher improvement rate of 33% compared with 11% in the non-pharmacist group (p = 0.03). Pharmacist interventions included 8 cases with instructions to improve medication adherence, 5 cases with withdrawal of vitamin D prescribed by other medical institutions, 2 cases with a recommended change from prescribed regular nonsteroidal anti-inflammatory drugs, and 3 cases with a recommendation to improve blood pressure control. Our findings suggest that pharmacists working with doctors to optimize laboratory test values and prescription content and to improve adherence in patients with pre-dialysis kidney disease would lead to elimination of factors associated with worsening renal function and would thus prevent renal function decline.