Redefining Medication Management in Dialysis: A Kidney Pharmacy Quality Pyramid

John Wigneswaran, Wendy L. St. Peter, Allen R. Nissenson, Mahesh Krishnan, Richard Faris, Bryan Becker, Jonathan Lorch

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Patients with end-stage renal disease treated with dialysis are often prescribed complex medication regimens, placing them at risk for drug-drug interactions and other medication-related problems. Particularly in the context of a broader interest in more patient-centered value-based care, improving medication management is an increasingly important focus area. However, current medication management metrics, designed for the broader patient population, may not be well suited to the specific needs of patients with kidney disease, especially given the complexity of medication regimens used by dialysis patients. We propose a kidney pharmacy-focused quality pyramid that is intended to provide a framework to guide dialysis organizations, health care providers, and/or clinicians with respect to an optimal medication management approach for dialysis patients. Incorporation of core programs in medication management, including medication reconciliation, safety programs, and medication therapy management for patients at high risk for medication-related problems, may result in improved outcomes. Although a growing body of evidence supports the concept that active medication management can improve medication adherence and reduce medication-related problems, these strategies are viewed as costly and are not widely deployed. However, if done effectively, pharmacy-led medication management has the potential to be one of the more cost-effective disease management strategies and may greatly improve outcomes for these complex patients.

Original languageEnglish (US)
Pages (from-to)307-314
Number of pages8
JournalKidney Medicine
Issue number5
StatePublished - Sep 1 2019

Bibliographical note

Funding Information:
John Wigneswaran, MD, Wendy L. St. Peter, PharmD, Allen R. Nissenson, MD, Mahesh Krishnan, MD, Richard Faris, PhD, Bryan Becker, MD, and Jonathan Lorch, MD. None. Dr Wigneswaran is an employee of Express Scripts/Cigna and holds stock and options in that company. Drs Nissenson, Krishnan, and Becker are employees of DaVita, Inc, and hold stock and options in that company. Dr Becker is also a member of the board of the Forward Health Group. Dr St. Peter serves on the board of directors of the Kidney Health Initiative. Dr Faris was an employee of DaVita Rx, is currently an employee of PANTHERx Specialty Pharmacy, and has held shares in DaVita, Inc. Dr Lorch is an employee of Rogosin Institute and has served as a consultant to DaVita, Inc. The authors acknowledge the assistance of Dena E. Cohen, PhD, a medical writer employed by DaVita Clinical Research, with the preparation of this manuscript. Received March 25, 2019. Evaluated by 3 external peer reviewers, with direct editorial input from an Associate Editor and the Editor-in-Chief. Accepted in revised form June 23, 2019.

Publisher Copyright:
© 2019 The Authors


  • end-stage renal disease
  • medication management
  • pharmacy


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