Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach

Clin J Am Soc Nephrol. 2013 Nov;8(11):1988-99. doi: 10.2215/CJN.01420213. Epub 2013 Aug 29.


Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model.

MeSH terms

  • Cooperative Behavior
  • Cost Savings
  • Cost-Benefit Analysis
  • Delivery of Health Care, Integrated* / economics
  • Drug Costs
  • Drug Interactions
  • Humans
  • Inappropriate Prescribing
  • Interdisciplinary Communication
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / economics
  • Kidney Failure, Chronic / therapy*
  • Medication Reconciliation* / economics
  • Medication Therapy Management* / economics
  • Patient Care Team
  • Pharmaceutical Services* / economics
  • Polypharmacy
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / economics
  • United States