A Pilot Study Embedding Clinical Pharmacists Within an Interprofessional Nephrology Clinic for the Initiation and Monitoring of Empagliflozin in Diabetic Kidney Disease.
A Pilot Study Embedding Clinical Pharmacists Within an Interprofessional Nephrology Clinic for the Initiation and Monitoring of Empagliflozin in Diabetic Kidney Disease.
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一项在跨专业肾脏病诊所中嵌入临床药剂师的初步研究，用于启动和监测恩格列净治疗糖尿病肾病。
DOI：
10.1177/0897190019876499
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发表时间：
2021-06
影响因子：
1.3
通讯作者：
Paik JM
中科院分区：
文献类型：
--
作者：
Triantafylidis LK;Hawley CE;Fagbote C;Li J;Genovese N;Paik JM
美国糖尿病协会（ADA）推荐钠-葡萄糖协同转运蛋白-2（SGLT 2）抑制剂作为慢性肾病（CKD）患者二甲双胍后开始使用的第二种药物。钠-葡萄糖协同转运蛋白-2抑制剂可能导致容量、血压和电解质紊乱;因此，可能需要频繁监测和调整其他糖尿病、血压和/或利尿药物。评价肾脏科医生和药剂师合作启动和监测SGLT 2抑制剂的跨专业诊所模式的安全性和疗效。一名临床药剂师被嵌入肾脏病诊所，提供患者教育，电话随访，并与肾脏病学家合作。恩格列净治疗开始后，根据需要调整糖尿病、高血压和利尿剂治疗方案。对糖尿病治疗方案进行了调整，以遵守2019年ADA指南，该指南促进了具有CKD和动脉粥样硬化性心血管疾病益处的药物。研究期间，14例患者开始接受恩格列净治疗。尿白蛋白/肌酐比值（UACR）改善（平均变化百分比-12% ± 61%）;基线UACR较高的患者的平均变化百分比更大。血红蛋白A1 c的平均变化为0.3% ± 0.6%。观察到常见不良反应，并随时间推移而改善;未发生严重药物不良反应。最后，几乎所有患者（n = 13，93%）开始恩格列净治疗时都需要调整糖尿病、高血压和利尿剂方案。在肾脏病诊所内实施创新的跨专业护理模式，用于在DKD患者中启动和监测恩格列净，证明了临床获益，安全性问题最小。
The American Diabetes Association (ADA) recommends sodium-glucose cotransporter-2 (SGLT2) inhibitors as the second medication to be started, after metformin, for patients with chronic kidney disease (CKD). Sodium-glucose cotransporter-2 inhibitors may cause volume, blood pressure, and electrolyte disturbances; consequently, frequent monitoring and adjustments to other diabetes, blood pressure, and/or diuretic medications may be necessary. To evaluate the safety and efficacy of an interprofessional clinic model partnering nephrologists and pharmacists for the initiation and monitoring of SGLT2 inhibitors. A clinical pharmacist was embedded within the nephrology clinic to provide patient education, telephone follow-up, and to work collaboratively with the nephrologists. Diabetes, hypertension, and diuretic regimens were adjusted as needed after empagliflozin initiation. Diabetes regimens were adjusted to adhere to the 2019 ADA guidelines that promote agents with CKD and atherosclerotic cardiovascular disease benefit. Fourteen patients were initiated on empagliflozin during the study period. Urine albumin-to-creatinine ratio (UACR) improved (mean % change −12% ± 61%); the mean percentage change was greater in patients with a higher baseline UACR. The mean change in hemoglobin A1c was 0.3% ± 0.6%. Common adverse reactions were observed and improved over time; no serious adverse drug reactions occurred. Finally, empagliflozin initiation necessitated adjustments to diabetes, hypertension, and diuretic regimens in almost all patients (n = 13, 93%). The implementation of an innovative, interprofessional care model within a nephrology clinic for the initiation and monitoring of empagliflozin in patients with DKD demonstrated clinical benefit with minimal safety concerns.
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影响因子：
2.3
作者：
Cooney D;Moon H;Liu Y;Miller RT;Perzynski A;Watts B;Drawz PE
通讯作者：
Drawz PE
影响因子：
13.6
作者：
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影响因子：
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影响因子：
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影响因子：
2.3
作者：
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通讯作者：
Cai, Jennifer