Screening for chronic kidney disease in communitypharmacy: Crierfac project

Introduction

Chronic kidney disease (CKD) is underdiagnosed in most countries. One reason for this is that it often presents without symptoms, so patients only seek medical attention when the disease is already advanced. Community pharmacies, due to their widespread reach and accessibility to healthcare throughout the region, can be suitable centers to complement screening efforts at primary care centers.

Objectives

To evaluate the outcomes of CKD screening in community pharmacies through creatinine measurement and glomerular filtration rate (GFR) estimation in patients meeting specific risk criteria.

Methods

Multicenter observational study. People who entered participating pharmacies for any reason and met the inclusion criterion of not having a CKD diagnosis were invited to participate in the study. Pharmacist conducted a point-of-care blood creatinine test, and the GFR was calculated using the CKD–EPI formula. Those with a positive CKD indicator (<45 ml/min/1.73 m2) were referred to their general practitioner (GP) for evaluation. People with a GFR>60 ml/min/1.73 m2 were not considered to have CKD. Those with a GFR between 45 and 60 ml/min/1.73 m2 were asked to return for reassessment 1 month later. All the data were recorded by the pharmacist.

Results

One hundred and forty-one community pharmacies from 40 provinces of Spain enrolled 2116 patients. In the first analysis, 1428 (67.5%) were negative, 165 (7.8%) were positive, and 523 (24.7%) needed a second analysis. In the second analysis, 164 (7.8%) were negative, 243 (11.5%) were positive, and 116 (5.5%) did not reattend. In summary, by intention to treat, 1592 (75.2%) were negative and 408 (19.3%) tested positive and were referred to their GP.

Conclusions

The results of CKD detection in community pharmacies are in line with screening in other healthcare settings, confirming they could be a reliable resource in future population-screening strategies

Key messages

• Chronic kidney disease (CKD) is underdiagnosed in most countries so it’s neccessesary to develop new points to screen patients.

• Community pharmacies, due to their widespread reach and accessibility to healthcare throughout the region, can be suitable centers to complement screening efforts at primary care centers.