Dynamic Medication Challenges in Hemodialysis: Rethinking Medication Therapy Management Strategies Through Longitudinal Trends.

RATIONALE &

OBJECTIVE

A pharmacist-led Hemodialysis-Medication Therapy Adherence Clinic mitigates drug-related problems (DRPs), yet its poorly understood trajectory keeps strategies reactive, limiting timely interventions. Longitudinal trends of DRP prevalence, characteristics, and associated factors of patients attending a Hemodialysis-Medication Therapy Adherence Clinic were explored.

STUDY

DESIGN

Retrospective longitudinal cohort study.

SETTING &

PARTICIPANTS

Complete records of adult patients undergoing maintenance HD who attended the Hemodialysis-Medication Therapy Adherence Clinic between January 2021 and August 2023 at a tertiary public hospital in Malaysia were included and examined.

EXPOSURE: Hemodialysis-Medication Therapy Adherence Clinic consisting of medication reconciliation, review and record, medication-related action plan, intervention, documentation, and follow-up.

OUTCOMES: Longitudinal trends, characteristics, and predictive factors of DRPs.

ANALYTICAL APPROACH: Prevalence was descriptively analyzed. Characteristics were classified using the Pharmaceutical Care Network Europe Association DRP Classification (v9.0), and predictive factors were determined using generalized linear mixed models.

RESULTS

A total of 76 patients' records involving 569 visits across 11 time points were included, with 546 DRPs identified. Longitudinal analysis showed high prevalence with periodic fluctuations, reaching the highest at visit 4 (n = 74, 13.6%) and lowest at visit 11 (n = 20, 3.7%). The DRP of suboptimal drug-treatment (P1.2) was the highest, followed by unnecessary drug-treatment (P3.2) in all visits, except in visit 7, where both categories were equally divided, whereas P3.2 predominated followed by P1.2 at visit 9. Patient-related factors, particularly nonadherence, were the primary causes across all visits except visit 9, where dose selection predominated. Multivariable analysis reported visit phase and anemia treatment had higher likelihood of clinically driven DRP, whereas longer hemodialysis duration and monitoring and administration-related issues reduced this likelihood.

LIMITATIONS: This single-center retrospective study was limited by reduced generalizability and attrition over time.

CONCLUSIONS

Identifying temporal patterns and predictors of DRPs can optimize Hemodialysis-Medication Therapy Adherence Clinic delivery. Future prospective multicentered research is warranted to increase generalizability and scalability.