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Kidney Week

Abstract: SA-PO651

Multipronged Systems Approach to Enhance Medication Safety in Patients with CKD

Session Information

  • Pharmacology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 1700 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)


  • Zheng, Sijie, The Permanente Medical Group, Oakland, California, United States
  • Wu, Dennis Y., Kaiser Permanente, Modesto, California, United States
  • Duong, Lin, HMO, Vacaville, California, United States
  • Jonelis, Tracy Y., The Permanente Medical Group, Inc, San Francisco, California, United States

Group or Team Name

  • KPNC Renal Pharmacy Group

In the United States, 1 in 7 people have chronic kidney disease (CKD), over 650,000 people have end stage renal disease (ESRD). Patients with CKD experience polypharmacy with ESRD patients taking average 10-12 prescriptions. Pharmacokinetic differences in CKD/ESRD patients require increased awareness and dose adjustment to minimize adverse events from prescription and OTC medications or herbal supplements. Kaiser Permanente Northern California (KPNC) is an integrated health care system that provides care to 4.3 million members with over 300,000 CKD patients through 21 medical centers.


In 2016, a workgroup was formed to improve medication safety for patients with CKD. The workgroup comprises of nephrologists, pharmacists and pharmacy informatics across the region. The work group met monthly via web conferencing. The workgroup outreached to relevant stakeholders and decision-makers between meetings. Leveraging Electronic Medical Record (EMR) and the expertise of the members, the workgroup used a multipronged systems approach to identify gaps and developed standardized protocols. The work group also optimized processes to enhance medication safety in CKD and to reduce acute kidney injury (AKI).


In the inpatient setting, the work group standardized protocols for antibiotic dosing, created order sets to minimize use of nephrotoxic agents including elimination of sodium phosphate enema use, and implemented calcineurin inhibitor drug interaction alerts. Additionally, EMR alerts are being placed for outpatient prescriptions that require dose adjustment or are contraindicated in CKD. In the home setting, herbal supplements and OTC medications tip sheet was produced for patient education and kidney protection.


In an integrated healthcare system such as KPNC, creation of an integrated nephrology pharmacy workgroup may help develop objectives and provide implementation strategies to reduce potential adverse medication events in patients with CKD.


  • Private Foundation Support