April 10, 2025
Jo Ellen Rodgers, Pharm.D., FCCP, FHFSA, FAHA, BCCP, BCPS
All Aboard: Clinical Pharmacists Leading the Charge
Last month, ACCP was invited to participate in a roundtable hosted by the National Kidney Foundation (NKF). The meeting was conducted with individuals representing several pharmacy organizations, and I had the opportunity to provide input as a clinical pharmacist. This gathering of pharmacist leaders focused on a crucial shift in patient care—one in which pharmacists can drive change.
Charting the Course: A Critical Shift in Medication Decisions
In 2021, NKF and the American Society of Nephrology Task Force recommended adopting race-free CKD-EPI equations for kidney disease diagnosis and medication dosing. A 2024 NKF Workgroup article1 outlined several factors supporting the transition:
- The Cockcroft-Gault (C-G) equation, developed in 1973 using data from 249 White men, lacks validation for diverse populations or with the standardized serum creatinine assays used today.
- Pharmacokinetic studies of new medications have increasingly used eGFR to evaluate kidney function, leading to increased drug labeling based on eGFR instead of C-G estimated creatinine clearance (C-G eCrCl).
- The FDA issued guidance in 2024 recommending use of eGFR over C-G eCrCl to evaluate the impact on pharmacokinetics in patients with impaired kidney function.
- New evidence shows that for several medications, using the CKD-EPI 2021 equation adjusted for an individual’s body surface area to estimate eGFR better predicts clearance than C-G eCrCl.
Building a New Track: How Pharmacists Can Drive Change
The NKF Workgroup recommends a collaborative approach to implementing race-free eGFR equations, including:
- Raising Awareness. Educating pharmacists on the need for this transition including establishing a sense of urgency
- Professional Training. Building confidence in applying the eGFR equation in practice
- Consensus Building. Securing endorsement from the Joint Commission of Pharmacy Practitioners
- Integration into Workflows. Ensuring seamless adoption in electronic health records and pharmacy systems
- Patient Education. Equipping those affected by kidney disease with accessible information
With a multidisciplinary team at NKF leading implementation efforts, pharmacists have an opportunity to respond to their request for support and guide this transition.
Punching Our Ticket to Leadership
This is a call to action for clinical pharmacists. No other health professional is better equipped to ensure patients receive the right medication, at the right dose, at the right time.
Reflecting on The Polar Express, the train conductor punched each child’s ticket with words of wisdom: Believe, Lead, Learn, Rely On. These virtues resonate with clinical pharmacists:
- BELIEVE—We are the best-suited health care professionals for this task.
- LEAD—It’s time for us to drive this change in medication management.
- LEARN—We must educate ourselves and our colleagues on implementing eGFR equations.
- RELY ON—Collaboration with colleagues and medical teams will be the key to success.
The train is leaving the station—will you get on board? Let’s take the lead and make this transition happen!
Reference
1. St. Peter WL, Bzowyckyj AS, Anderson-Haag T, et al. Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: a consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Am J Health Syst Pharm. 2024 Nov 18:zxae317. https://doi.org/10.1093/ajhp/zxae317