Improving Medication Safety and Prescribing for Individuals Chronic Kidney Disease (CKD) Through the Implementation and Evaluation of an Electronic Drug Dosing and Decision Support Kidney (eDoseCKD) Tool for Nova Scotia Community Pharmacy.

Exploring an Innovative Solution to Optimize Chronic Kidney Disease Management

Chronic kidney disease (CKD) is categorized by a sustained reduction of estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73m2 . The prevalence of CKD in Canada is approximately 12.5 %, representing nearly 3 million adults . In Canadian primary care practices, the prevalence of CKD is 71.9 per 1000 individuals and is highest in rural settings compared to urban settings . Multiple comorbidities, advanced age, and polypharmacy are common in CKD . Many drugs are primarily eliminated by the kidneys and inappropriate dosing can lead to drug accumulation. Considering these factors, the risk for adverse drug events and further harm to kidney function is high in this population .

CKD patients are often exposed to inappropriately prescribed medications which lead to adverse outcomes . In Canada, adverse drug reactions resulting in emergency room visits or hospitalization carry a significant economic burden to the system and health impacts to the individual. A recent Canadian primary care resource outlined key medications to be dose-adjusted or avoided with CKD. The Nova Scotia Health Renal Program published a support tool for primary care providers which included medications to avoid and common drugs requiring renal dose adjustment in those with CKD. Despite the development of these resources, a recent primary care study involving advanced CKD (eGFR less than 60 ml/min/1.73m2) patients in Nova Scotia, found that nearly 20% of high-risk medications that should be dose-adjusted or avoided were not . A possible drawback of these resources is they lack practical suggestions on specific dosing or how to stop a medication, necessary monitoring, appropriate alternatives considering drug coverage or ideal prescribing to protect or preserve kidney function.

Limited progress has unfortunately been made in the past twelve years since the Canadian pharmacotherapy assessment in chronic renal disease (PAIR) instrument revealed that 21% of drug therapy problems in community pharmacy were related to inappropriate use or use of a contraindicated medication . Further, the Canadian Institute for Health information in 2021-2022 reported potentially inappropriate medication prescribing in seniors with rates that were nearly 15% higher in Nova Scotia compared to Canada . This research aims to address the medication prescribing gap that is acute in Nova Scotia through an innovative solution to optimize the resources and capacity of community pharmacists while ensuring safety and quality of medication prescribing in those with CKD.

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