What's new?

This is the first review focusing on the potential role of pharmacists in the screening of chronic kidney disease (CKD) in community pharmacies. CKD detection can be carried out by pharmacists in various ways, including the use of essential renal parameters and risk stratification. Moreover, the role of pharmacists goes beyond screening and they may also contribute to effective CKD management. The findings highlight the importance of early‑stage CKD detection, which is often asymptomatic, and show a common lack of awareness of CKD risk factors in the general population. Therefore, pharmacists could help improve CKD detection rates and contribute to better long‑term outcomes, leading to enhanced patient quality of life and economic benefits for the health care system.

Introduction

Chronic kidney disease (CKD) is defined as abnormalities in kidney structure or function persisting for more than 3 months, with implications for health. CKD is diagnosed based on at least 1 of 2 criteria documented or inferred for over 3 months: 1) glomerular filtration rate (GFR) below 60 ml/min/1.73 m² or 2) markers of kidney damage, such as albuminuria.¹ CKD affects more than 700 million individuals worldwide, and its prevalence is increasing annually.² This rise is largely due to a lack of awareness of CKD risk factors and the absence of typical symptoms in the early stages, leading to late diagnosis. The most common cause of CKD worldwide is diabetes,¹ while hypertension is not only a major complication of the disease but also a key risk factor for its development.¹ Patients with CKD have a 10- to 20‑fold higher risk of cardiovascular disease (CVD).³

In Poland, the detection rate of CKD remains low⁴; however, there are ongoing initiatives that aim to determine its prevalence.⁵ There are no dedicated programs targeting its early diagnosis.⁴ Moreover, the long‑term national health policy plan for nephrology for the years 2022–2026 focuses primarily on palliative and hospice care, while preventive measures are largely overlooked.^4,6 Early diagnosis of CKD is, however, feasible within coordinated primary care services.^4,7 It is noteworthy that certain initiatives aim to raise awareness of CKD and facilitate its early detection in primary care settings. National consultants in nephrology and family medicine, together with the President of the Polish Society of Nephrology, have issued national guidelines on the diagnosis and management of CKD in primary care, with an emphasis on coordinated care models.⁸ However, pharmacists are currently not engaged in these activities.

Pharmacists can play a crucial role in CKD screening and patient education. The International Pharmaceutical Federation (FIP) has introduced the CKD pharmacy toolkit to help pharmacists identify at‑risk patients and provide motivational counseling to encourage CKD screening.¹ Its primary goal is to increase the number of undiagnosed at‑risk patients referred for CKD screening, thereby facilitating earlier diagnosis and management. CKD prevention and management involve setting and achieving therapeutic goals, identifying the need for nephroprotective therapy (eg, angiotensin‑converting enzyme inhibitors [ACEIs], sodium‑glucose cotransporter‑2 inhibitors [SGLT2is], or finerenone), and ensuring appropriate monitoring.¹ Medication reviews provide an opportunity to identify and discontinue nephrotoxic medications and adjust dosages as needed.¹ Slowing CKD progression in its early stages could yield economic benefits and, most importantly, prevent kidney failure and cardiovascular complications.¹ Notably, cardiovascular mortality is one of the leading causes of death among CKD patients.¹

This study systematically reviewed and discussed findings from original research investigating the role of pharmacists in CKD screening in community pharmacies. It aimed to find out if there are any scientific reports on pharmacist‑led interventions in community setting that facilitate CKD detection, and if so, what specific types of interventions are implemented, how effective they are in CKD screening, and how they contribute to improved patient outcomes.

Patients and methods

This systematic review was conducted in accordance with the 2020 PRISMA guidelines.⁹ Eligible publications included full‑text articles in English or Polish describing pilot programs, pharmaceutical care interventions, or educational activities that assessed the role of pharmacists in detecting CKD.

Exclusion criteria comprised conference abstracts, guidelines or expert statements, opinion papers, preprints, and publications that did not report outcomes of pharmacist‑led interventions.

A comprehensive search was performed across 3 databases—PubMed, Embase, and the Cochrane Library—on March 17 and March 21, 2025. The final search update was conducted on July 4, 2025.

A majority of the included studies were observational ones; 1 study was a subanalysis of a randomized controlled trial, but all other studies were nonrandomized. The inclusion criteria were defined using the PICO (Population, Intervention, Comparison, Outcome) framework. The studies only included adults without a formal diagnosis of CKD, and must have investigated pharmacist‑led activities (eg, medication review, screening, patient counseling, laboratory test referral) aimed at detecting CKD. They had to compare standard pharmacist practice / usual pharmacy care (without targeted CKD detection activities), and their outcome had to be the detection of CKD based on eGFR or albumin‑to‑creatinine ratio (ACR), identification of albuminuria, classification of patients as having a moderate or high CKD risk according to the QKidney algorithm, or CKD diagnosis confirmed through pharmacist‑facilitated consultation of renal function parameter with a general practitioner (GP).

The following search query was used: “(CKD OR chronic kidney disease OR renal insufficiency OR kidney insufficiency) AND (detection OR screening OR identification) AND (community pharmacy OR pharmacist).”

A comprehensive search strategy was developed to identify relevant studies. Various combinations of key words were used to ensure a wide range of studies were captured (Supplementary material, Tables S1–S3).

This yielded a total of 419 records. The records were imported into Rayyan platform (Rayyan Systems, Inc. Cambridge, Massachussets, United States) for screening.

After removing 160 duplicates, 259 titles and abstracts were independently screened by 2 researchers (AO and MR). Any discrepancies were resolved through discussion, with the involvement of a third reviewer (AD). This process yielded 32 records that initially met the inclusion and exclusion criteria. Full texts of these 32 articles were retrieved and assessed for eligibility.

Ultimately, 23 studies were excluded: 12 because the population or intervention did not meet the PICO criteria, 5 due to publication type (eg, research letters rather than full‑text original articles), 4 because they were not in English or Polish, and 1 due to a lack of reported outcomes. One duplicate was also removed. As a result, 9 original clinical research articles were included in the final review. Figure 1 summarizes the flow diagram of the study selection process.

Data extracted from each study included study design, population characteristics, description of the pharmacist‑led intervention, reported risk factors for CKD among participants, and primary outcomes.

Risk of bias was assessed using the ROBINS‑I tool, version 2 for nonrandomized studies, evaluating 7 domains: confounding, participant selection, classification of interventions, deviations from intended interventions, missing data, outcome measurement, and selective reporting.¹⁰ Each domain was rated as having low, moderate, serious, or critical risk of bias.¹⁰ The study did not require approval from an institutional review board or ethics committee.

Results

In Tables 1 and 2 we summarize the pharmacist‑led interventions for CKD detection in patients with common risk factors, such as diabetes and hypertension. Frequently reported risk factors included hypertension, diabetes, age, vascular disease, obesity, smoking, and family history of CKD.

Primary outcomes included detection of undiagnosed CKD and proteinuria; secondary outcomes were identification of individuals at an increased 5‑year CKD risk and follow‑up rates with GPs.

All studies demonstrated feasibility of pharmacist‑led CKD screening. Interventions typically recruited high‑risk patients during pharmacy visits or by using dedicated tools, such as the SCORED (Screening for Occult Renal Disease) questionnaire¹¹ and QKidney calculator.¹² The patients scoring 4 or higher on SCORED questionnaire were classified as high‑risk and offered education alongside the urine dipstick test to assess the ACR.¹¹ The patients with a 5‑year risk equal to or above 3%, as determined by the QKidney calculator, received personalized letters addressed to their physicians, and all of them were followed‑up by telephone after 9 months.¹² The screening procedures included eGFR and / or albuminuria testing, using devices such as PICCOLO^13,14 (a validated point‑of‑care tool; Zoetis Inc, Parsippany, New Jersey, United States), StatSensor¹⁵ (a blood chemistry analyzer for venous blood testing to assess creatinine levels and estimate GFR; Nova Biomedical, Waltham, Massachussets, United States), or the urine dipstick test.^11,16 The patients with positive urine dipstick test results for albuminuria underwent confirmatory laboratory testing, and were then referred to a primary care unit for further evaluation.

In another intervention, Al Hamarneh et al¹⁷ reported a screening process embedded within the RxEACH (The Alberta Vascular Risk Reduction Community Pharmacy Project) study. The pharmacists identified eligible patients based on recent laboratory data and medication history—specifically prescriptions for antihypertensives or hypoglycemics. If the required laboratory tests had not been completed within the previous 12 months, the pharmacists ordered them as part of the intervention. This pharmacist‑led screening not only contributed to improved renal outcomes but also significantly enhanced patient awareness of CKD prevention. In a study by Srimongkhol et al,¹⁶ mean (SD) self‑awareness score regarding CKD increased from 6.43 (2.34) to 8.06 (1.06) following pharmacist‑delivered education. Similarly, Vu et al¹⁸ concluded that general knowledge about kidney health improved, as 95% of the participants reported moderate or high confidence in interpreting their kidney test results after receiving education from a pharmacist.

Discussion

The review identified a limited number of studies addressing the detection of CKD by pharmacists. None of the identified publications were available in Polish or examined the Polish health care context.

Despite heterogeneity of the studies, common features included targeting high‑risk populations and using point‑of‑care technologies. Early CKD detection improves disease control, reduces complications, delays progression, and enhances outcomes.^24-26 Pharmacists can further optimize care by adjusting drug doses and avoiding nephrotoxic medications.^27,28