中国临床药学杂志

目的 对国内外慢性肾脏病（CKD）患者药物治疗管理和临床药学实践的现状进行系统评价，为深入开展CKD患者临床药学服务提供参考。方法 检索中文数据库（中国知网、万方数据库）和英文数据库（PubMed、Web Of Science、Cochrane）中CKD患者药物治疗管理和临床药学实践的相关文献，进行文献筛选、资料提取和信息汇总，采用Cochrane风险偏倚评估工具、美国卫生保健质量和研究机构（AHRQ）评分标准评估文献质量，并评价临床药师对门诊和住院的CKD患者开展药物治疗管理和临床药学服务的质量，以及临床药师干预对患者临床结局的影响。结果 共纳入13篇文献。通过系统评价发现，常见临床药学服务主要有临床药师通过参与多学科诊疗开展临床药学服务、临床药师主导药物治疗管理模式、医师-临床药师联合门诊服务和临床药师主导的居家用药管理。临床药师可以通过识别和干预患者的药物相关问题（DRP），向医师提供药物治疗方案优化建议，对患者开展用药教育和药物治疗，从而提高患者用药依从性和合理性。结论 临床药师开展针对CKD患者的药物治疗管理，有助于优化药物治疗方案，提高药物疗效和患者的生活质量。我国针对CKD患者开展临床药学服务的相关文献较少，药学服务内容也相对局限，未来应加强针对CKD患者的临床药学服务。

AIM To comprehensively evaluate the current status of medication therapy management and clinical pharmacy practice in patients with chronic kidney disease(CKD) at home and abroad, and to offer guidance for further advancement of clinical pharmacy services in CKD patients. METHODS Several main Chinese databases(China National Knowledge Infrastructure, Wanfang database) and English databases(PubMed, Web Of Science, Cochrane)were searched, followed by literature screening, data extraction, and information summarization. The Cochrane Risk of Bias assessment tool and the U.S. Agency for Health Care Quality and Research Evaluation Criteria were used to assess the quality of literature. The quality of drug therapy management and clinical pharmacy services provided by clinical pharmacists to outpatients and inpatients with CKD, clinical pharmacist interventions and their impact on patient clinical outcomes were evaluated. RESULTS A total of 13 articles were included. The comprehensive evaluation revealed that common clinical pharmacy services mainly included clinical pharmacists participating in multidisciplinary diagnosis and treatment to carry out clinical pharmacy services, clinical pharmacist-led drug treatment management mode,physician-clinical pharmacist joint outpatient service and clinical pharmacist-led home medication management. Clinical pharmacists could help patients effectively manage their medications, optimize drug regimens by providing medication suggestions to physicians, provide medication education to patients, manage medication therapy, and improve medication adherence and rationality in patients with CKD through identification and intervention of drug-related problems(DRP).CONCLUSION The medication therapy management services provided by clinical pharmacists contribute to optimizing drug therapy, and improving drug efficacy and quality of life in CKD patients. The relevant literature on clinical pharmacy services for CKD patients in China is relatively scarce, and the content of the services is also more limited,indicating a need to strengthen clinical pharmacy services for CKD patients.