The effects of pharmacist-led medication therapy management on medication adherence in patients with pre-end stage renal disease

We read with great interest the published article of Ting et al describing “The Effects of Pharmacist–led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-inflammatory Drug in Patients with Pre-End Stage Renal Disease.” We appreciated the importance of assessing “The Effects of Pharmacist-led Medication Therapy Management on Medication Adherence in Patients with Pre-End Stage Renal Disease”[1]. We propose the future implication of medication therapy management services and insight on burden of non-adherence to renin angiotensin agents Patients with renal failure hemodialysis (HD) patents commonly receive poly-pharmacy leading to increased likelihood of patients’ non-adherence to renal medicines[2]. Non-adherence to oral medications is common in chronic kidney disease (CKD) patients, with mean non-adherence rates of 67% due to the occurrences of poly-pharmacy[3]. Higher rates of non-adherence to medication have been linked to a higher risk of death in hemodialysis patients[4]. Therefore, the author should assess the associated risk factors of non-adherence among CKD patients. Medication therapy management (MTM) services discover and resolve medication non-adherence among end stage renal disease. Besides, medication therapy management has a positive impact on CKD as well as HD patients by reducing hospitalization and improving health related quality of life[2]. It entails conducting a medication review, selecting an effective therapy, determining and addressing any drug-related problem during follow-up evaluation, and providing patient education to improve adherence to the treatment[5]. Patients with CKD receiving treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have seen considerable cardiovascular protection and preserved residual renal function[6]. Treatment with ACE inhibitors is linked to a significant decline in the mortality rate in dialysis patients[7]. Even though renin-angiotensin agents were the cornerstone in the treatment of advanced CKD[8], the author did not mentioned the risk associated with discontinuation of this medications. Renin angiotensin agents should be sustained in severe chronic renal disease[9]. ACEIs/ARBs still underutilized despite data from several trials demonstrating the advantages of improved morbidity and mortality[10]. Renal illness patients are most likely to stop receiving treatment[11]. Within 5 years of starting treatment, ACEI/ARB is stopped in more than half of chronic renal disease patients[12]. Discontinuation of ACEI/ARBs is associated with an increased risk of cardiovascular-renal events in patients with advanced-CKD[8]. Future researcher should focus on the associated factors and effect of non-adherence to ACEI/ARB on clinical outcomes among patients with advanced stage of renal disease. Non-adherence to oral medications is common in CKD patients due to the occurrences of poly-pharmacy. Renin angiotensin agents should be sustained in severe chronic renal disease. Despite this, within 5 years of starting treatment, ACEI/ARB is stopped in more than half of chronic renal disease patients. Discontinuation of ACEI/ARBs is associated with an increased risk of cardiovascular-renal events in patients with advanced-CKD. Future researcher should focus on the associated factors and effect of non-adherence to ACEI/ARB on clinical outcomes among patients with advanced stage of renal disease.