Influence of Clinical Pharmacist intervention on the Quality of Life of Anemic Patients with Chronic Kidney Diseases in the Hemodialysis Setting in Kirkuk-Iraq.


  • Bushra Hassan Marouf Department of Pharmacology and Toxicology, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq
  • Intisar Ahmed Yusif Department of Pharmacology, Kirkuk Medical College, University of Kirkuk, Kirkuk, Iraq
  • Raad Hassan Najim Department of Microbiology, Kirkuk Medical College, University of Kirkuk. Kirkuk, Iraq



Clinical pharmacist, Intervention, Quality of life, Anemia, Chronic kidney disease



To assess the impact of pharmacist intervention on the health related quality of life (QoL) among anemic patients with chronic kidney diseases in a hemodialysis center.



A single blind, randomized control study was carried out at the hemodialysis center of Kirkuk Hospital in Kirkuk-Iraq. The patients were randomized into two groups; interventional group received clinical pharmacist services delivered by a qualified registered pharmacist and non-interventional group received usual hospital care and. The pharmacist proposed clinical interventions at the level of patients, drugs, hospital level to improve the patient’s quality of life. The impact of clinical pharmacist’s intervention on improving quality of life of patients was assessed by using the Rand 36-Item Short Form Health Survey questionnaire. The assessment of the QoL was carried out for both groups for a total of 4-month follow-up; at baseline, day 60 and day 120.


A total number of 120 patients were recruited from the hemodialysis centers and 1437 interventions were applied for interventional group (n=60), 41.4% at the drugs level, 51.1% at the patient level and 7.5% at the hospital and administrative level. The health related QoL scores were significantly improved over time in the domains noticed with regard to the “physical functioning, general health, emotional role” of interventional group compared to the baseline and non-interventional group with conventional hospital care with P <0.05.


 Interventions provided by the pharmacist had a positive impact on QoL of anemic patients in the hemodialysis center of the city.  


- McIntyre CW, Goldsmith DJ. Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension? Kidney Int. 2015;87(6):1109–15.

- KGIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Nephrology and Dialysis. 2017;19(1):22-206.

- Subbiah A, Chhabra Y, Mahajan S. Cardiovascular disease in patients with chronic kidney disease: a neglected subgroup. Heart Asia. 2016;8(2):56-61.

- Pulignano G, Del SD, Di LA, Tinti MD, Tarantini L, Cioffi G, et al. Chronic renal dysfunction and anaemia are associated with cognitive impairment in older patients with heart failure. J Cardiovasc Med (Hagerstown). 2014; 15(6):481–90.

- Eriksson D, Goldsmith D, Teitsson S, Jackson J, van Nooten F. Cross-sectional survey in CKD patients across Europe describing the association between quality of life and anaemia. BMC Nephrology. 2016;17(1).

- Bailey RA, Reardon G, Wasserman MR, McKenzie RS, Hord RS. Association of anemia with worsened activities of daily living and health-related quality of life scores derived from the minimum data Set in long-term care residents.Health Qual Life Outcomes. 2012; 10:129.

- Rizzo M, Iheanacho I, Van Nooten F, Goldsmith D. A systematic literature review of the humanistic burden of anaemia associated with chronic kidney disease. Value in Health. 2013; 16(7): 381-382.

- Painter P, Moore G, Carlson L, Paul S, Myll J, Phillips W, Haskell W: Effects of exercise training plus normalization of hematocrit on exercise capacity and health-related quality of life. Am J Kidney Dis. 2002; 39:257–265.

- Joshi V. Quality of life in end stage renal disease patients. World Journal of Nephrology. 2014;3(4):308.

- Moreno F, Aracil FJ, Perez R et al. Controlled study on the improvement of quality of life in elderly hemodialysis patients after correcting end-stage renal disease-related anemia with erythropoietin. Am J Kidney Dis.1996; 27: 548–556.

- Dowling TC. Prevalence, etiology, and consequences of anemia and clinical and economic benefits of anemia correction in patients with chronic kidney disease: an overview. Am J Health Syst Pharm. 2007; 64 (13 Suppl 8): S3–S7; quiz S23–S25.

- Kimura T, Arai M, Masuda H, Kawabata A. Impact of a Pharmacist-Implemented Anemia Management in Outpatients with End-Stage Renal Disease in Japan. Biological & Pharmaceutical Bulletin. 2004;27(11):1831-1833.

- Ohnishi J, Miyake A, Kuwatsuka K, Onoue Y, Lee M, Koyama T, et al. Effect of pharmacist management on serum hemoglobin levels with renal anemia in hemodialysis outpatients. Biol Pharm Bull. 2011;34(10):1609–12.

- Viktil KK, Blix HS: The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008; 102(3):275-280.

- Salgado T, Moles R, Benrimoj S, Fernandez-Llimos F. Pharmacists' interventions in the management of patients with chronic kidney disease: a systematic review. Nephrology Dialysis Transplantation. 2011;27(1):276-292.

- Bonomini M, Del Vecchio L, Sirolli V, Locatelli F. New Treatment Approaches for the Anemia of CKD. American Journal of Kidney Diseases. 2016;67(1):133-142.

- Debenito J, Billups S, Tran T, Price L. Impact of a Clinical Pharmacy Anemia Management Service on Adherence to Monitoring Guidelines, Clinical Outcomes, and Medication Utilization. J Manag Care Spec Pharm. 2014;20(7):715-720.

- Ali M, Khedr E, Ahmed F, Mohamed N. Clinical pharmacist interventions in managing drug-related problems in hospitalized patients with neurological diseases. International Journal of Clinical Pharmacy. 2018;40(5):1257-1264.

- Yailian A, Revel E, Tardy C, Fontana A, Estublier C, Decullier E et al. Assessment of the clinical relevance of pharmacists' interventions performed during medication review in a rheumatology ward. European Journal of Internal Medicine. 2019; 59:91-96.

- Zhao Q, Jiang S, Chen J, Zhang X, Lu X. Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital. Therapeutics and Clinical Risk Management. 2014;861.

- Curtis BM, Ravani P, Malberti F, et al. The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes. Nephrol Dial Transplant 2005; 20:147–54.

- Grabe DW, Low CL, Bailie GR, Eisele G. Evaluation of drug-related problems in an outpatient hemodialysis unit and the impact of a clinical pharmacist. Clin Nephrol 1997; 47:117–21.

- Abduelkarem AR. Extending the role of pharmacists in patient care: Are pharmacists in developing nations ready to change? Pharmacol Pharm 2014; 5:865-875.

- KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney international. Supplement. 2. 1-335. 10.1038/kisup.2012.1.

- Mikhail A, Brown C, Williams J, Mathrani V, Shrivastava R, Evans J et al. Renal association clinical practice guideline on Anaemia of Chronic Kidney Disease. BMC Nephrology. 2017;18(1).

- Hays R, Sherbourne C, Mazel R. The rand 36-item health survey 1.0. Health Economics. 1993;2(3):217-227.

- Stewart AL, Hays RD, Ware Jr JE. The MOS short-form general health survey. Reliability and validity in a patient population. Med Care 1988; 26: 724–735.

- Fujisawa M, Ichikawa Y, Yoshiya K, Isotani S, Higuchi A, Nagano S, et al. Assessment of health related quality of life in renal transplant and hemodialysis patients using the SF 36 health survey. Urology 2000; 56:201 6.

- Mollaoglu M. Fatigue in people undergoing hemodialysis. Dial Transplant 2009; 38:216-220.

- Dąbrowska-Bender M, Dykowska G, Żuk W, Milewska M, Staniszewska A. The impact on quality of life of dialysis patients with renal insufficiency. Patient Preference and Adherence. 2018; 12:577-583.

- Langebrake C, Hilgarth H. Clinical pharmacists’ interventions in a German University Hospital. Pharmacy World & Science. 2010;32(2):194-199.

- McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumption, and reliability across diverse patient group. Med Care. 1994; 32:40–66.

- Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. Association among SF-36 quality of life measures and nutrition, hospitalization and mortality in hemodialysis. J Am Soc Nephrol. 2001; 12:2797–806.

- Pai AB, Boyd A, Chavez A, Manley HJ. Health-related quality of life is maintained in hemodialysis patients receiving pharmaceutical care: a 2-year randomized, controlled study. Hemodial Int. 2009; 13:72–79.

- Lins L, Carvalho F. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Medicine. 2016; 4:2050312116671725. doi: 10.1177/2050312116671725

- Chisholm MA, Spivey CA, Mulloy LL. Effects of a medication assistance program with medication therapy management on the health of renal transplant recipients. Am J Health Syst Pharm 2007; 64: 1506–1512.

- Dashti-Khavidaki S, Sharif Z, Khalili H, Badri S, Alimadadi A, Ahmadi F, et al. The use of pharmaceutical care to improve health-related quality of life in hemodialysis patients in Iran. Int J Clin Pharm. 2013;35(2):260–267.

- Mateti U, Nagappa A, Attur R, Nagarapu S, Rangaswamy D. Impact of pharmaceutical care on the health-related quality of life among hemodialysis patients – A multicenter randomized controlled study. Saudi Journal of Kidney Diseases and Transplantation. 2017;28(6):1293.

- Abraham S, Ramachandran A, Raman S, Venu A, Chandran P. Assessment of quality of life in patients on hemodialysis and the impact of counseling. Saudi Journal of Kidney Diseases and Transplantation. 2012;23(5):953.

- Al Raiisi F, Stewart D, Fernandez-Llimos F, Salgado T, Mohamed M, Cunningham S. Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review. International Journal of Clinical Pharmacy. 2019;41(3):630-666.