Integrated Care Likely to Improve ESRD Patient Outcomes

By Dr. Frank Maddux, Chief Medical Officer and Executive VP, Clinical and Scientific Affairs, at Fresenius Kidney Care North America (FMCNA)

Managing medications can be a challenging part of renal disease care, especially because many patients take several different medications at various times throughout the day.

At FMCNA, we are always looking for opportunities to build an environment of quality, safety and efficiency in how we deliver coordinated care to our patients with advanced kidney disease, including support with medication management. One way we have done this is by providing a coordinated care approach that includes FreseniusRx pharmacists as an integral part of our patients’ multidisciplinary healthcare team.

With FreseniusRx, we are able to bring specialists who understand that people with renal disease and their unique medication needs will benefit from pharmacist intervention and attention to medication management and monitoring. These specialized pharmacists support physicians, clinical managers, dietitians, social workers and nurses to help their patients be more knowledgeable about their medications so they understand the importance of each medication and can get the most out of their dialysis care team and therapy.

The partnership between our 2,000+ Fresenius Kidney Care centers and the FreseniusRx team means we have pharmacists certified as renal specialists readily available to review all of our patients’ medications. This includes spotting patients’ other medication therapies, identifying adverse reactions and reporting them to the patient’s physician, and preventing potential drug interactions. This added oversight helps our prescribing physicians provide safer, more efficient care.

The renal-specific pharmacy approach FreseniusRx brings likely improves outcomes for people with advanced kidney disease. When our patients chose to use Fresenius Rx as their pharmacy, we recently examined whether patients who did so experienced improved outcomes more frequently than those who are not taking advantage of this more coordinated medication process.

In late 2015, we conducted a study of more than 57,600 FMCNA patients, half of whom were enrolled in FreseniusRx and half of whom received bone and mineral metabolism medications from other pharmacies. These populations shared many similar characteristics, including demographics and diagnosis, so we could gain a clear picture of the degree to which making FreseniusRx their pharmacy of choice was associated with their health outcomes.

  • We learned that within their first nine months of enrollment, FreseniusRx patients experienced a 9 percent improvement in their target ranges for blood calcium, phosphorus and intact parathyroid hormone goals, compared to patients who were not using FreseniusRx1.
  • We also evaluated these patients based on their rates of hospitalization. Again, we saw the tremendous value the FreseniusRx pharmacy brings to our patients – results showed that patients were up to 11 percent less likely to be hospitalized within their first nine months with FreseniusRx2.

While these results are preliminary, our Medical Office analytics organization is working with external and internal pharmacists, physicians, statisticians and epidemiologists to make this information publicly available in peer-reviewed publications.

Our patients with renal disease are likely to benefit from a relationship with FreseniusRx. Renal specialist pharmacists can play a unique and important role in helping patients understand and adhere to their medication, providing more connected and coordinated care for patients within the Fresenius Kidney Care network of care providers.


1 Rosen S, Larkin J, Thekkumkattil J, Brownlee N, Roberts S, Usvyat L, Hymes J, Ketchersid T, Maddux FW. A renal pharmacy coordinated care program is associated with improvements in bone mineral metabolism outcomes in hemodialysis patients (based on preliminary internal analysis).

2 Roberts S, Rosen S, Thekkumkattil J, Brownlee N, Larkin J, Usvyat L, Hymes J, Ketchersid T, Maddux FW. Associations between a renal pharmacy based coordinated care program and decreased rates of hospitalizations in hemodialysis patients (based on preliminary internal analysis).