Managing Chronic Kidney Disease(CKD) during Covid-19

Covid-19 not only affected healthcare delivery but it also ruptured people’s access to healthcare due to large deficit of medications and doctors. People with added ailments such as immune-deficiency diseases and chronic ailments received the worst of the lot. Research has proven that people who suffer from (CKD)are much more vulnerable to develop complications while to have Covid-19. Around 10-15% of the world population suffers from CKD. The news is only made worse with the fact that contracting Covid-19maycause damage to the kidneys. Covid-19 Virus penetrates into extrapulmonary organs, harming them and resulting in systematic inflammation and hypercoagulability. There are various tests conducted on these patients generally show high proteinuria, haematuria and blood urea. Since the body is in an already weakened state, it is much easier to develop pneumonia which increase mortality rate by almost 15%.

Pharmacists, through repeated multiple interventions can play a major role in achieving safety standards of the patients. In renal disease,  history of the patient should be checked thoroughly by the pharmacist and accordingly choice of medications should be adjusted. A principal duty of any pharmacist is promoting medical adherence especially in a country like India which reports numerous cases of low adherence. India faces large disruption to medical supplies on account of its population, factory closures and lockdowns.

Recent efforts in this direction have seen nephrologists referring their CKD patients to a pharmacist for optimum medication management. Studies have reported significant improvements in these CKD patients in ambulatory care as a result of this physician-pharmacist collaborative agreement.

The medicines administered to patients during Covid-19 need to be properly eliminated to avoid sub-therapeutic or supra-therapeutic drug interactions. Renal dysfunction can alter this drug elimination process and hence, require close monitoring and dose adjustments. Pharmacists also need to identify and rectify adverse drug reactions in these susceptible patients. Two or more drugs whose interaction may prove detrimental to the patient may not be apparently visible in front of the distressed people. It is therefore the duty of the pharmacists to watch out for such lethal drug-drug interactions, which is only possible through a more individualized therapy and much more focused approach from the pharmacist’s side. A recent phenomenon has been the increased prescription of antivirals to tackle Covid-19. However, not much attention is paid to the special populations while prescribing such contradicting medications.

Kidneys have tiny filters called glomeruli which help to remove waster and excess fluid from blood. A glomerular filtration rate of less than 30 mL/min is symptom of kidney impairment and many Covid-19 medicines such as one of the most effective ones, Favipiravir, prove detrimental in such patients. Kidney also filters out creatinine, a waste product generated due to physical activity. Thus, while administering covid-19 medications it is absolutely important to keep a check on the rise in the levels of serum creatinine. In the worst events of sepsis and dehydration a complete hemodynamic evaluation is necessary. Such side effects have a high risk of causing more harm than good with these medicines. Thus, the crucial role of pharmacists over here lies in carefully selecting, dosing and monitoring side effects, rational use of medication and other types of treatments in Covid-19patients.

Discuss more of such topics at the Pharmacy College at Amrapali Institute, Haldwani. Amrapali Educational Institute is a top ranked institute in Uttarakhand.

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