Nephrology at its Finest

Posted by Adam Loyson at Tuesday, September 03, 2013

Beginning my last year of pharmacy school about to start rotations, I was bottled up full of emotions with many questions unanswered.  Am I up for the challenge?  Was I going to be able to recall every guideline from all those long study nights?  What is going to be expected of me?  Hesitant and uncertain, I admittedly entered my first advanced pharmacy practice experience nervous.  Yet, at the same time I felt eager to enter the final stage as a student pharmacist.  What I didn’t know was how fast my first rotation was going to take my knowledge of disease management to the next level.

Strictly the Kidney

Entering the hospital on my first day, I knew my first rotation was going to be in an environment I had never experienced before: enter the world of nephrology.  Combining components from both ambulatory care and inpatient care, I found myself following patients who were brand new to hemodialysis and peritoneal dialysis as inpatients and continuing with their transition into the outpatient hemodialysis clinic.  Not only did I find patients requiring dialysis who had progressive kidney damage due to comorbidities but also those who developed acute kidney injury from a single toxic drug exposure or severe hypotension episode.    Never before had I recognized the immense delicacy of our kidneys!  It became apparent after interviewing several patients with kidney disease that health professionals have to consider multifaceted physiological, economic, and quality of life factors when managing drug therapy in this population. 

Another neat aspect in covering kidney disease was observing how mechanical dialyzers, responsible for cleaning patients’ blood of chemical waste products, operate through filtration.  Pharmacy plays a big role in overcoming the challenges these machines present by determining which drugs are filtered out and by how much.  For substantial portions of my day, you will find me performing antibiotic regimen calculations and referencing alternative dosing regimens for medications that are cleared from the blood during dialysis, being certain not to over- or under-dose patients to prevent toxicity and protect residual kidney function.  For those patients with remaining kidney function, I am reminded of the importance of having the handy Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) equations memorized along with a calculator available at your fingertips to quantify kidney function and to adjust drug dosing.

Comprehensive Patient Care

Unable to adequately perform the necessary kidney function to sustain life, kidney disease patients utilize mechanical dialyzers on a scheduled basis, multiple times per week.  Such regular visits to the dialysis unit present me with countless opportunities to further develop the clinical skills I learned thus far from my pharmacy education.  Every day, I am able to complete medication histories and inform patients on how to slow the progression of kidney failure.  I really get a kick out of encouraging patients to follow a healthy diet, participate in an active lifestyle, how to better adhere to their medication regimens, and educating them on appropriate medication administration for improved outcomes.  In addition, I actively participate in a multidisciplinary healthcare team of nephrologists, renal dieticians, renal social workers, and outpatient dialysis nurses to make certain that patient electrolyte values are within normal limits (many accumulate), supplementation is made with erythropoiesis-stimulating agents when appropriate, proper vaccinations are administered, and quality of life is assessed.  I find that the healthcare team is always very accepting of recommendations on my behalf to change therapy if needed.  Moreover, my interviewing and counseling skills are placed in the spotlight during each patient discharge given that the management of kidney disease relies heavily on individual patient participation for optimal therapy.

Learning As I Go

Every day of rotation that passes, I grow more confident in my pharmacy knowledge and become increasingly satisfied knowing that I made an impact on patient care.  With two weeks under my belt, I can already feel my career interests molding into a clearer picture of what I would like to pursue upon graduation.  While pharmacy rotations can be daunting at first, I have learned to embrace these diverse experiences.  After all, this is the best time to get your hands dirty and learn your perfect fit in pharmacy.  Stay tuned to read about my experiences in critical care next!