Specialty Pharmacy Improves Control of Secondary Hyperparathyroidism

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This article is part of our ongoing coverage of Renal Week 2009. Click here for a complete list of our Renal Week Live articles.


Key Points

  • Participation in a specialty pharmacy improved control of secondary hyperparathyroidism in hemodialysis patients.
  • According to the investigators, calcium and intact parathyroid hormone control was significantly more likely to improve than worsen following six months of participation.
  • Results were not due to an increase in the number of prescriptions to manage secondary hyperparathyroidism.

Participation in a specialty pharmacy improved control of secondary hyperparathyroidism in hemodialysis (HD) patients, researchers reported at ASN's Renal Week 2009.

Stephanie L. Brillhart, Clinical Research Coordinator at Denver Nephrology Research in Denver, Colo., and colleagues examined the changes in secondary hyperparathyroidism control associated with enrollment in the renal-focused, specialty pharmacy, DaVita Rx.

Created in 2005, DaVita Rx provides tailored prescription drug services to patients with end-stage renal disease, including medication delivery to patients in DaVita clinics. The goal of DaVita Rx is to remove common access barriers, thus improving compliance and outcomes, and reducing cost of care.

The researchers performed a before-and-after analysis of 1,603 patients undergoing HD in DaVita HD centers before Sept. 1, 2004 and who were also enrolled in DaVita Rx.

Using average calcium, phosphorus, and intact parathyroid hormone (iPTH) levels three months before enrollment (baseline) and at six months post-enrollment, they compared control of secondary hyperparathyroidism according to definitions established by the Kidney Disease Outcomes Quality Initiative (KDOQI).

According to the investigators, calcium and iPTH control was significantly more likely to improve than worsen following six months of participation in DaVita Rx. At baseline, 36.9% of subjects had iPTH levels within KDOQI targets. At six months, 21.7% moved into the KDOQI recommended range whereas 17.4% had moved out of the range. At baseline, 56.5% of subjects were within the KDOQI recommended range for calcium. At six months, 21% had moved into that range and 14.8% had moved out.

Investigators observed no improvement in phosphorus levels. After adjustment, results were not due to an increase in the number of prescriptions to manage secondary hyperparathyroidism, the researchers reported.

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