Pharmacist-Led Intervention to Improve Serum Potassium Levels, Knowledge

Dietary restriction of potassium is an accepted way to help prevent hyperkalemia. However, it may not be sufficient for outpatients with chronic kidney disease (CKD).

In a prospective cohort study published in PLOS ONE, Yuki Asai and other researchers examined the efficacy of a community pharmacist-led nutritional intervention for outpatients with CKD. In Japan, where the study took place, most outpatients with CKD use community pharmacies.

The MieYaku-CKD project was a five-community pharmacy study with an open-label, before-and-after comparison design. It sought to determine whether a community pharmacist-led nutritional intervention for dietary potassium restriction would improve serum potassium levels and awareness about potassium among outpatients with CKD.

There were 25 patients aged ≥18 years included in the cohort; 19 were male, and 6 were female. Their estimated glomerular filtration rate (eGFR) was <45 mL/min/1.73 m². All eligible patients were followed for 12 weeks. The primary outcome was change in serum potassium levels from baseline to 12 weeks. The secondary outcome was change in patients’ attitudes about potassium restriction at 12 weeks. A questionnaire was used to assess patients’ knowledge, awareness, and implementation of potassium restriction.

Following the pharmacist-led intervention, median serum potassium was significantly lower, measuring 4.7 mEq/L before the intervention and 4.4 mEq/L after the intervention (95% CI, 0.156-0.500; P<.001). There were no changes in eGFR (95% CI, −2.427 to 2.555; P=.563) or blood urine nitrogen/serum creatinine ratio (95% CI, −1.793 to 1.214; P=.904).

A subgroup study compared the reduction of serum potassium levels between the eGFR <30 and eGFR ≥30 mL/min/1.73 m² groups. In the former group, serum potassium values had a tendency of attenuation from 5.3 to 4.6 mEq/L (95% CI, 0.272-1.114; P=.046).

After the intervention, knowledge of and attitudes about dietary potassium restriction had improved, which implies that the decrease in serum potassium levels may be related to the nutritional guidance pharmacists provided.

There were several limitations to the study, including the small sample size, seasonal variations in hyperkalemia, lack of nephrologists’ involvement, and inclusion of only outpatients at a secondary hospital in Japan. Researchers could not determine the long-term persistence of dietary potassium restriction, the efficiency of the intervention in patients receiving hemodialysis, or the extent to which the patients’ diets changed.

“Our findings indicate that implementing a dietary potassium restriction guidance program in community pharmacies is feasible and may result in lower serum potassium levels in outpatients with CKD,” the authors wrote. “Although few studies have demonstrated the benefits of community pharmacist activities in practice, the implementation of nutritional interventions, such as potassium restriction, for patients with CKD by educated community pharmacists certainly contributes directly to the improvement of community populations’ health,” they concluded.

Source: PLOS ONE