IDENTIFYING PATIENTS WITH CKD USING STICKERS ENHANCES PHARMACISTS’ MANAGEMENT OF CKD

Community pharmacists play an important role in ensuring safe and effective care of patients with chronic kidney disease (CKD) by reviewing prescriptions and providing appropriate medication guidance. However, in community pharmacy practice, the pharmacists often lack access to renal function data, making it difficult to recognize patients with CKD and make informed decisions regarding dose adjustments or counseling. This constrains their capacity to avert inappropriate prescriptions and provide optimal pharmaceutical care. To address this problem, a “CKD Sticker” system has been introduced, in which a sticker is affixed to a patient’s medication handbook, which visibly indicates the presence of CKD. This simple tool allows pharmacists to recognize patients with CKD immediately and encourages close attention to renal-related medication management and counseling. We aimed to elucidate how CKD stickers affect pharmacists’ recognition of CKD and their daily practices in community pharmacies in Niigata, Japan.

We distributed a questionnaire to community pharmacists in Niigata City, Japan, who provided medication counseling to patients having medication handbooks with CKD stickers from July 15, 2020, to January 31, 2025. Each pharmacist answered the questionnaire immediately after instructing patients. The questions are as follows: 1. Did you know that this patient had CKD, even without the CKD sticker? 2. How did you know that the patient has CKD? 3. Are there any medications for patients requiring dosage adjustments depending on renal function? 4. How does your understanding of CKD influence your daily work? 5. Did you provide CKD-related counselling to patients with CKD? 6. Are there any other information or materials besides the CKD stickers that are useful in daily work?

A total of 114 valid questionnaires were collected from pharmacists. Pharmacists newly recognized CKD in 56% patients because of the sticker (64/114). Recognition of patients with CKD was significantly improved by the CKD sticker using McNemar test (χ²=64.0, p<1×10⁻¹⁴). Other reasons for recognition included patient interviews (33.8%), prescriber’s specialty (15.0%), and prescription content (11.3%). Medications requiring consideration for renal dose adjustment were included in 44% of the prescriptions; the most frequent classes were lipid-lowering agents (21%), oral anticoagulants (15.8%), antidiabetic drugs (15.8%), and hyperuricemia treatments (14%). Recognizing CKD helped pharmacists in their work: increased attention was paid to prescription content (36.3%); prescription inquiries were made with greater confidence (22.5%); CKD-specific patient counseling was done (20.8%); and pharmacists were prompted to ask detailed questions about renal function, medication use, and lifestyle during patient interviews (20.4%). Overall, 46% pharmacists were involved in CKD-related counseling, including further explanations of prescribed drugs (44.4%), adherence support (22.2%), dietary guidance (15.9%), and lifestyle counseling (6.3%). Pharmacists also requested desired resources, including detailed renal function data (42.4%), standardized patient pamphlets (32.8%), and dialysis status (24.7%).

The CKD Sticker substantially improved the pharmacists’ recognition of CKD and supported safer and more proactive care through focused review, dose adjustment, and patient counseling in community pharmacies. By making the CKD status visible at a glance, the sticker helped bridge the information gap, which often hinders appropriate pharmacist intervention. In addition to medication-related interventions, pharmacists provided guidance beyond traditional pharmacy practices, including lifestyle and dietary advice. Strengthening this multidisciplinary approach may further enhance the effectiveness of patient-centered CKD education and long-term disease management.