Consensus Study Sets Standard Outcomes for CKD Pharmacist Trials

Research in pharmacist interventions for chronic kidney disease (CKD) has long been hard to compare across trials, because studies measure wildly different things. A new Delphi consensus study published in the Journal of Nephrology sets out to fix that, establishing the first intervention-specific core outcome set for pharmacist research in CKD—a defined minimum list of outcomes every trial should report. For pharmacists, it signals which contributions to CKD care the field has agreed are worth measuring, from medication error to adherence.¹

Why Standardized Outcomes Matter

The investigators noted that heterogeneity in reported outcomes limits interpretation, hampers research synthesis, and increases research waste. While core outcome sets are well established in nephrology through initiatives such as Standardized Outcomes in Nephrology (SONG), none had focused specifically on pharmacist interventions, a gap the authors argue is meaningful, because the outcomes most relevant to a pharmacist’s work may differ from those in broader nephrology trials.¹

How the Consensus Was Built

The study ran across 3 phases between July 2023 and March 2024: a systematic review and international online survey to generate a long list of outcomes, a 2-round e-Delphi survey in which stakeholders rated each outcome's importance on a 9-point scale, and a final online consensus workshop. Consensus for inclusion was set a priori at 75% of participants rating an outcome "critical." A total of 109 participants completed the first phase, and the group encompassed pharmacists, researchers, other health care professionals, people living with CKD, and their family members or carers.¹

The 5 Essential Outcomes

Following the 2 Delphi rounds, 25 outcomes reached the provisional set; the final core outcome set comprised 23 outcomes, sorted into "essential" and "important" tiers. Five outcomes landed in the essential tier and, per the authors, should be measured in all studies of pharmacist interventions in CKD: health-related quality of life, kidney function, medication adherence, medication error, and medication use.¹

Several of these map directly onto daily pharmacy practice. The authors pointed out that many medications require dose adjustment as kidney function declines, that medication adherence is a persistent challenge given the pill burden in CKD, and that patients with CKD are more prone to medication errors owing to reduced kidney function, multiple comorbidities, and complex regimens.¹

Lead author Ashkon Ardavani, PharmD, PhD, a pharmacist and research associate at the University of Leicester and the study’s lead author, told Pharmacy Times that adherence is likely the least measured of the 5 in day-to-day practice, despite its essential status. “For a medication review in CKD, medication adherence is likely the outcome that is least measured in practice today,” he said.

He attributed this partly to the absence of a standardized measurement tool—noting that his team’s earlier systematic review and meta-analysis of pharmacist interventions in CKD identified 5 separate adherence measures across 11 studies—and partly to time constraints that can keep pharmacists from critically evaluating a patient's medication-taking behavior.^1,2

Ardavani also outlined a proactive role for pharmacists at the point of dispensing and reconciliation. He suggested identifying patients with a clinically significant reduction in eGFR and periodically reviewing every medication they take, including OTC products and herbal supplements, to determine what should be avoided, withheld, or dose-adjusted against the patient's most recent eGFR. That judgment, he said, depends on whether a drug is affected by renal impairment and whether the benefit of continuing it outweighs the risk. Any change, he added, should be communicated to both the patient and the prescriber, with a plan to monitor electrolytes, kidney function, and other relevant markers.²

Limitations and What Comes Next

The authors flagged that most participants were UK-based, so the findings apply most directly to UK pharmacist studies, and that the fully online design may have underrepresented people without reliable internet access, such as some on dialysis. They also note that the work identified which outcomes to measure but not how to measure them, calling for a follow-up review to establish validated measurement instruments and cautioning that uptake of CKD core outcome sets has historically been poor.¹

REFERENCES

1. Ardavani A, Curtis F, Highton P, Khunti K, Wilkinson TJ. Developing a core outcome set for pharmacist interventions in chronic kidney disease: a Delphi study. J Nephrol. 2026;39(4):799-809. doi:10.1093/joneph/aajag005

2. Ardavani A, Curtis F, Hopwood E, et al. Effect of pharmacist interventions in chronic kidney disease: a meta-analysis. Nephrol Dial Transplant. 2025;40(5):884-907. doi:10.1093/ndt/gfae221