By: Allison Currie
Did you know that one in ten Canadians is affected by chronic kidney disease (CKD)?
While kidneys play a vital role in filtering wastes, making red blood cells, controlling blood pressure, and keeping bones healthy, they also remove many medications from the body. Certain medications may need the dose adjusted to prevent buildup to avoid side effects, including further kidney damage.
Dr. Karthink Tennankore, a nephrologist at Nova Scotia Health and professor of medicine at Dalhousie University says that while medications are essential for managing health issues, some medications can place additional strain on the kidneys if not dosed properly.
This means that ensuring medications are appropriately prescribed is crucial for improving the health and quality of life of people living with CKD.
Dr. Jo-Anne Wilson, an affiliate scientist with Nova Scotia Health, associate professor of pharmacy in the Faculty of Health at Dalhousie University, and associate scientist with the Maritime SPOR SUPPORT Unit, is leading important research in this area. Her passion for medication safety was sparked early during her pharmacy career when she recognized how critical pharmacists are in supporting safe medication use.
“Working closely with individuals with kidney disease, showed me the importance of how medication management can significantly improve health outcomes,” says Dr. Wilson. “This inspired me to focus on ways to enhance medication safety in those with CKD. Through collaboration with colleagues from various fields, we’ve been able to develop research that aims to make a difference in the care and safety of those with this condition.”
One way that Dr. Wilson’s team is making a difference stems from research conducted in 2023 with community pharmacists, who identified the need for an evidence-based, expert-informed dosing tool of high-risk medications in individuals with low kidney function.
Katie Halliday, a pharmacy student and Mitacs intern working with Dr. Wilson, says people with kidney disease are often excluded from drug studies, leading to limited information and inconsistencies in drug resources, which complicate dosing decisions.
Aiming to enhance medication safety, reduce risks and improve patient outcomes, Dr. Wilson is developing an electronic drug dosing and decision support kidney tool called eDoseCKD in collaboration with her team and various partners, including community pharmacists, who are well-positioned to optimize prescribing practices of higher-risk medications.
In fact, community pharmacists continue to be central to all phases of the research.
The first phase included developing and validating the high-risk medication decision support algorithms for the tool. Over the next several months, the research team will be working with Virtual Hallway, a Nova Scotia digital health platform launched in collaboration with the Nova Scotia Health Innovation Hub and the CAN Health Network, to computerize the medication algorithms for their eDoseCKD tool implementation and evaluation study in a dozen community pharmacy intervention sites in the province.
Maneka Sheffield, a renal pharmacist with Nova Scotia Health, believes this tool is very important because those with CKD face many medication risks.
“I’m excited about how this tool will support community pharmacists and improve medication safety for patients with CKD,” says Sheffield.
Dr. Steven Soroka, senior medical director for the NSH Renal program says it’s not uncommon to hear about a patient in the emergency department who is experiencing an adverse drug event due to receiving a dose higher than necessary for their level of kidney function.
Bottom L-R: Dr. Steven Soroka, (senior medical director for the NSH Renal program), Deena Backman (patient partner), Dr. Jo-Anne Wilson (Scientific Affiliate)
Because the patient experience is key, patient involvement is also a key factor in this research.
Dr. Wilson is working with two patient partners, Deena Backman and Jessica Pelletier, who have both struggled with CKD. Deena says growing up with polycystic kidney disease has had a significant impact on her day-to-day life but has taught her resilience. She says the tool adds an extra layer of protection for patients which could prevent harmful medication effects and ensuring safer, personalized care.
Both Deena and Jessica also emphasized the importance of patient participation in health research. They have co-created a patient bulletin and video related to medication safety for those with kidney disease.
“Patient involvement is crucial because it brings a personal perspective that data alone can’t provide,” says Deena. “People like Jessica and I are just two of the many faces affected by kidney disease. Our insights can shape the development of tools that truly address patient needs and improve outcomes for everyone. We’re helping to create innovative solutions that could make a difference for other people with kidney disease.”
Dr. Ashley Hilchie, senior director of research at Nova Scotia Health, couldn’t agree more.
To assess the impact of the edoseCKD tool, Dr. Wilson and her team will evaluate its reach (the number of people benefiting), effectiveness (impact on medication safety), adoption (acceptance by community pharmacists), implementation (real-world execution) and maintenance (long-term sustainability). Feedback from pharmacists and patients will be collected through surveys and interviews, focusing on the tool's ease of use, educational materials, and impact on medication safety.
In the long term, the edoseCKD tool aims to promotes a proactive approach to medication dosing and safety for individuals with kidney disease in primary care, with the potential to be scaled to all community pharmacies in Nova Scotia and beyond.
Dr. Wilson’s research has been funded by Research Nova Scotia, Mitacs Accelerate Internship Program and the Nova Scotia Health Research Fund.
Research is care, and clinical studies help translate research into potentially life-changing therapies that can help you, your friends and your loved ones. Want to know more about how to get involved? Visit Nova Studies Connect today: novastudiesconnect.ca
