Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial

Area of Science:

• Nephrology
• Pharmacology
• Health Services Research

Background:

• Chronic kidney disease (CKD) is associated with high rates of hospitalization and readmission.
• Effective interventions are needed to reduce acute care utilization in CKD patients post-discharge.

Purpose of the Study:

• To evaluate a pharmacist-led medication therapy management (MTM) intervention aimed at reducing acute care utilization in CKD patients after hospitalization.

Main Methods:

• A randomized clinical trial (CKD Medication Intervention Trial) involving 141 patients with CKD stages 3-5 not on dialysis.
• The intervention consisted of a single home visit by a pharmacist within 7 days of discharge, including medication review, action plan, and personal medication list.
• The primary outcome was a composite of acute care utilization (hospital readmissions, ED visits, urgent care visits) within 90 days post-hospitalization.

Main Results:

• The primary outcome occurred in 44% of the intervention group and 41% of the usual care group (P=0.72).
• Hospital readmission rates were 26% in both the intervention and usual care groups (P=0.95).
• No significant between-group differences were observed in achieving guideline-based goals for renin-angiotensin system inhibition or key clinical parameters (BP, hemoglobin, phosphorus, PTH).

Conclusions:

• A pharmacist-led MTM intervention did not significantly reduce acute care utilization in CKD patients transitioning from hospital to home.
• The findings suggest that this specific MTM intervention may not be effective in mitigating post-hospitalization acute care needs in this population.