DaVita® Medical Insights

Integrated Kidney Pharmacies for Improved Results

End stage renal disease (ESRD) patients compose one of the most costly and complex patient populations, requiring substantial coordination and communication across the care spectrum to optimize clinical results. The number of comorbidities and subsequent medications lends to this group’s complexity: One-third of ESRD patients have four or more comorbidities when first diagnosed with ESRD and, on average, they consume 19 pills a day. Those within the top quartile take more than 25 pills daily. These medications are often difficult to swallow and are associated with side effects and drug interactions. In addition, medication adherence rates in renal patients average at 50 percent. Based on recent data, medication non-adherence in all patients in the United States can cause up to 125,000 deaths, up to 20 percent of hospital and nursing home admissions, and up to $300B in avoidable health care costs annually.

Integrated kidney-specific pharmacy services are often helpful to educate patients, coordinate prescriptions and optimize medication safety and adherence. Studies have shown that an integrated kidney pharmacy program can significantly decrease mortality risk, hospital admissions and hospital days.

An effective integrated kidney pharmacy can include the following elements:

  • Kidney pharmacists who participate in dialysis care team discussions and highlight medication changes or concerns that may not be considered by other members of the team.
  • A closed provider loop that optimizes communication between providers—such as nephrologists and pharmacists—to lessen the possibility for medication errors.
  • A focus on most-vulnerable patients to ensure that they receive the care they need and reduce medical costs.
  • Targeted medication reviews that review high-risk medications, ensure a current medication list and reduce errors related to dosages, allergies or interactions.
  • Refill reminders and prescription medication deliveries to dialysis facilities or homes.
  • Services that provide patients with payment options and insurance advocates that can reduce monetary challenges and increase medication adherence.
  • Kidney pharmacists who are available for telephonic consultations.
  • Regulatory and legal practices to ensure proper prescription medication procedures.
  • Drug utilization review for patient safety.
  • Continuous staff education to understand the complexity of ESRD and common comorbidities and to develop the ability to best recommend and assist with optimal interventions.

As a part of integrated kidney pharmacy efforts, it is critical to conduct ongoing studies and review consumer psychographic datasets (behavior geographic location, Fair Isaac Coorporation (FICO®) scores and social media) to gain further understanding into behavioral aspects of medication adherence. Patients don’t simply “forget” to take medications. They have real and unique reasons, such as lack of access or not understanding the medications, their disease, why the medications are important for their overall health, or what medications may be appropriate (based on the side effects they may be having). To better understand reasons for non-adherence—and to identify innovations that could address this and other kidney pharmaceutical-related concerns—DaVita is conducting (or has recently completed) the following four studies.

  1. The first study highlights that the more medications a patient receives from a single integrated pharmacy, the better their clinical outcomes. Early non-published data in the southern California market demonstrates this, and a larger follow-up retrospective analysis will begin next quarter.
  2. The second study is reviewing the differences in medication adherence rates by specific medications, such as a blood pressure medication versus a phosphorus binder, and studying whether patients at DaVita Rx experience better adherence rates.
  3. The third study, which is launching in July, will test smart pill bottle technology to improve adherence to clinically important medications. The pill bottles send a cellular signal to alert the clinician that a prescription medication has not been taken, allowing clinicians to intervene earlier on critical medication misses.
  4. Lastly, DaVita recently published a meta-analysis of around 1,000 ESRD patients, accepted and presented at this year’s National Kidney Foundation meeting, which revealed how pharmacists intervening in high-risk ESRD patients can impact hospitalizations.

Leveraging research and analytics and developing medication protocols and tools can improve integrated kidney pharmacy services—ultimately helping to reduce hospitalizations and mortality and enhance patient quality of life.



Note: Davita RX is a wholly owned subsidiary and affiliate of DaVita Kidney Care.

John R. Wigneswaran, MD

John R. Wigneswaran, MD

John R. Wigneswaran, MD, is chief medical officer for DaVita Rx and vice president of clinical affairs at DaVita Kidney Care. Before joining DaVita, he was medical director in medical affairs of Johnson & Johnson, chief medical officer for CHF Solutions, Inc. (Gambro) and vice president of market development at Fresenius Medical Care. Dr. Wigneswaran founded Nephroceuticals, an organization focused on improving nutritional health of patients with chronic diseases. He was certified by both the Boards of Internal Medicine and Nephrology and is a member of the American Society of Nephrology. He received his medical degree from Tufts University School of Medicine, renal fellowship from Cornell University and MBA from the Massachusetts Institute of Technology.