Evaluation of a chronic kidney disease risk assessment service in community pharmacies

Aim: Targeted 'opportunistic' screening might be a sustainable approach for the early detection of people with undiagnosed chronic kidney disease (CKD). The aim of this study was to implement and evaluate a CKD risk assessment service in the community pharmacy setting.

Methods: Twenty-four pharmacies in Tasmania, Australia participated in this study. Targeted people were aged between 50-74 years, with at least one CKD risk factor. The QKidney® risk calculator was used to estimate the participants' 5-year percentage risk of developing moderate-severe CKD. Participants identified with ≥ 3% risk were referred to their general practitioner (GP) and followed-up after 9 months. Laboratory data was collected from a pathology provider. The main outcome measures were rates of GP referral uptake and of participants who underwent estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) measurement.

Results: We analysed data for 389 screened participants, of whom 203 (52.1%) had ≥ 3% 5-year risk of developing moderate-severe CKD and were referred to their GP. Follow-up was successful for 126 participants and showed low (27%) GP referral uptake. Analysis of the pathology data revealed suboptimal kidney testing in participants with ≥ 3% risk, with eGFR and ACR tests performed for only 52.7% and 25.1% of these participants, respectively.

Conclusions: There is significant scope for improving early detection of CKD via implementation of a community pharmacy-based CKD risk assessment service. However, a healthcare system that encourages inter-professional collaboration between community pharmacists and GPs, and provides a robust referral pathway is needed to optimise the effectiveness of this service.