Ms Sharon Ho1, Dr Ramyasuda Swaminathan1, Dr Harish Puttagunta1, Dr Rebecca Hudson1, Dr Stephen Wright1, Dr Jacqueline Soraru1, Dr Zhan Lim1, Dr Ashley Irish1
1Fiona Stanley Hospital, Murdoch, Australia
Biography:
Specialist renal pharmacist. Awarded fellowship of the Australian and New Zealand College of Advanced Pharmacy as a Consultant Pharmacist in nephrology and transplantation. Completed honours thesis on pharmacogenetics and the Mayo Clinic certificate course on Clinical Implementation of Pharmacogenetics.
Background:
Patients with chronic kidney disease (CKD) have a high comorbid illness burden and are prescribed on average 10 to 12 separate medications. Polypharmacy contributes to increased rates of adverse drug reactions (ADRs) and medication non-adherence in up to 67% of stage V CKD patients. Medication optimisation using pharmacogenetic (PGx) testing and personalised prescribing may improve adherence, therapeutic efficacy, and reduce ADRs.
Aim:
To optimise medication regimes for CKD patients utilising pharmacogenetic testing and personalised medicine through a novel pharmacogenetics clinic.
Methods:
A pharmacist-led renal pharmacogenetics clinic was established for stage III to V CKD patients. PGx testing consisted of a panel screen for 10 pharmacogenes. Medication interventions were actioned in accordance with relevant PGx guideline recommendations and physician approval for patients:
• At risk of, or reported, a concentration dependent ADR and/or
• At risk of a sub-optimal therapeutic response or a experienced therapeutic failure.
Results:
Forty-nine patients were reviewed in the pharmacogenetics clinic over a 9-month evaluation period. All patients had 1 or more pharmacogene variants deemed at-risk of affecting medication outcomes. We actioned 56 medication interventions in 69.4% of patients (n=34) with 65 drug-gene interactions identified. The 3 most common drug-gene interactions involved statins (n=12), antihypertensives (n=11) and antidepressants (n=7). Over one-third of patients (n= 18) had medication ceased or substituted. Over half of the patients (n=26) received a total of 37 dose adjustments to reduce risks of ADRs or sub-therapeutic drug responses.
Conclusion:
Our study emphasised the clinical benefits of PGx for medication optimisation in CKD patients with advantages in deprescribing, drug selection and personalised dosing to improve medication safety and efficacy in this cohort.