The Role of Specialty Pharmacists in Managing Chronic Kidney Disease

Chronic kidney disease (CKD) is a significant public health concern that has been on the rise in the United States as well as worldwide. More than 1 in 7 US adults—which is about 35.5 million people—are estimated to have CKD.¹ As many as 9 in 10 adults with CKD and 1 in 3 adults with severe CKD do not know they have it.¹ CKD worsens over time and has multifactorial causes, including high blood pressure and diabetes. Although there is currently no cure for CKD, there are steps that can be followed to preserve kidney function for a sustained period of time. In the management of CKD, specialty pharmacists are well-positioned to educate, motivate, and monitor patients as well as collaborate with other health care providers.

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Specialty pharmacies focus on providing medications for serious health conditions requiring complex therapies, including infectious diseases, inflammatory conditions, and many others. Such pharmacies assemble highly trained clinical pharmacists who offer a more personalized approach to patient care, including education, counseling, and monitoring, as well as coordination with other health care providers. In 2019, the National Association of Specialty Pharmacy expanded the traditional specialty pharmacy services to certain designated diabetes and weight loss medications. Pharmaceuticals that belong to this specialty lite program fall under a specific whole acquisition cost range and have specific service-level requirements from the clinical pharmacy.²

Research has shown that certain specialty lite medications, such as glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), can help prevent or slow the progression of CKD in individuals with type 2 diabetes.³ Thus, proper usage, administration, and adherence to these medications can prevent worsening of kidney health in the diabetic patient population. Part of clinical pharmacist service is the review of proper administration techniques of GLP-1 RAs as well as a review of missed dose management in case there are lapses in adherence.

Specialty pharmacy programs include clinical pharmacist outreaches to patients and providers, monitoring patients’ laboratory results (eg, blood pressure, HbA_1c, estimated glomerular filtration rate [eGFR]), and completing routine medication reconciliation. Recent research has illustrated that pharmacist interventions resulted in statistically significant improvements in systolic blood pressure and hemoglobin levels in adults with a diagnosis of CKD.⁴ This is a substantial correlation, as high systolic blood pressure is strongly associated with the progression of CKD, particularly in stages 3 and 5. Specialty pharmacies help patients manage their multiple medications, including OTC and herbal supplements, which can be a significant challenge for those with CKD. The American Academy of Family Physicians states that up to 20% of kidney damage can be attributed to medications, including both prescription and OTC drugs.⁵ Therefore, even when a specialty pharmacist has a counseling session with a patient who has HIV, they can identify any potential drugs and/or interactions that may potentially worsen that patient’s kidney function.

Part of specialty pharmacists’ role—regardless of a patient’s specialty condition—is ensuring that their patient is being prescribed an appropriate medication dose. Pharmacists ensure medications are dosed appropriately based on a patient's objective bloodwork and always include the review of a patient’s eGFR and kidney function. Targeted oncology therapies, such as eGFR inhibitors and anti-angiogenesis inhibitors, can disrupt the delicate balance of kidney microvasculature, leading to alterations in kidney endothelium and subsequent proteinuria, high blood pressure, acute kidney injury, and even CKD.⁶ For these reasons, specialty pharmacists follow specific medication guidelines when verifying initial treatment doses of these medications and then monitor patients’ kidney functions during treatment to check for potential decline in kidney function. Consequently, clinical pharmacists collaborate with other members of a patient’s health team by recommending dose modifications or even treatment changes.

CKD is a complex condition that often co-exists with other health conditions, requiring complex medication regimens. Pharmacist-led counseling on patient illnesses can provide essential information to help patients adequately understand their health. Specialty pharmacists educate patients on health management, including lifestyle modifications and dietary restrictions, and provide various adherence strategies. Clinical data has proven that providing patients with a clear understanding of their conditions improves medication adherence.⁷ Being that the leading causes of CKD are diabetes and hypertension, adherence to medications and commitment to a healthy lifestyle are key preventative methods to promote kidney health. Individualized diet recommendations, physical activity, monitored sodium intake, dehydration prevention, and smoking cessation are commonly discussed with patients during routine pharmacist calls.

Pharmacists play an instrumental role in the management of chronic health conditions such as CKD. Specialty pharmacists can provide an array of clinical knowledge and expertise when counseling patients with various health conditions. A lot of medications that we consume, as well as our lifestyle choices, have considerable influence over our kidney health. Therefore, specialty pharmacists—regardless of patients’ initial specialty diagnosis—can make a significant impact in this patient population.

REFERENCES

1. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Updated May 15, 2024. Accessed May 14, 2025. www.cdc.gov/kidney-disease/php/data-research/index.html.

2. Antwerp GV. Growth of Specialty Lite may create challenges for RX stakeholders. Deloitte United States. August 8, 2024. Accessed May 14, 2025. https://www2.deloitte.com/us/en/blog/health-care-blog/2024/growth-of-specialty-lite-may-create-challenges-for-rx-stakeholders.html

3. Górriz JL, Romera I, Cobo A, O’Brien PD, Merino-Torres JF. “Glucagon-like Peptide-1 Receptor Agonist Use in People Living with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Narrative Review of the Key Evidence with Practical Considerations.” Diabetes Therapy. 2022;13(3):389–421. doi:10.1007/s13300-021-01198-5.

4. Ardavani A, Curtis F, Hopwood E, et al. “Effect of Pharmacist Interventions in Chronic Kidney Disease: A Meta-Analysis.” Nephrol Dial Transplant. 2024;40(5):884–907. doi:10.1093/ndt/gfae221.

5. Naughton, CA. “Drug-Induced Nephrotoxicity.” Am Fam Physician. 2008;78(6):743–750. www.aafp.org/pubs/afp/issues/2008/0915/p743.html#afp20080915p743-b1

6. Merchan JR, Jhaveri K. Nephrotoxicity of molecularly targeted agents and immunotherapy. UpToDate. October 14, 2024. Accessed May 14, 2025. https://www.uptodate.com/contents/nephrotoxicity-of-molecularly-targeted-agents-and-immunotherapy#references

7. Calleja L, Glass BD, Cairns A, Taylor S. Pharmacist-Led Interventions for Medication Adherence in Patients with Chronic Kidney Disease: A Scoping Review. Pharmacy. 2023;11(6):185. doi:10.3390/pharmacy11060185