Clinicians need to be aware of what medications a patient is prescribed before any changes can be made or new medications initiated. This can be a challenge since individuals with end stage renal disease who are receiving dialysis have a high medication burden with an average of 12 different prescriptions per day[1]. The financial burden, both for patients and payers is also substantial; with 77% of ESRD patients enrolled in Medicare part D, total estimated expenditures for enrollees reached $2.7 billion in 2014 for prescription medications[2].

Medication related problems, such as adverse drug reactions or over/under utilization, occur frequently in the dialysis setting and are often related to gaps in medical information transfer. Identifying these issues has the potential to reduce hospitalizations, improve quality of life, and use health care resources more efficiently. In a randomized controlled trial, dialysis patients assigned to receive medication reconciliation and management of medication related problems by a clinical pharmacist used 14% fewer medications and had almost half as many hospitalizations at the end of the two year intervention compared to the usual-care group[3]. However, systematic medication reconciliation is not routinely performed in most dialysis clinics due to lack of staff training, limited interfaces in electronic health information between care facilities (outpatient dialysis facilities, hospitals, skilled nursing facilities, and rehabilitation centers), and absence of clinical pharmacists in most dialysis facilities[4]. Because of the frequent contact between dialysis facilities and patients, medication reconciliation and management as a means to reduce medication related problems may represent an opportunity to improve quality of care.

Minding the Med List in Dialysis