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Rx for New Kidneys

– Natasha M. Splaine


“Medicine is not only diagnosing and writing a prescription,” said Marie Chisholm. “It involves social issues and issues concerning education.”

“Meet Mrs. Johnson.” Dr. Marie Chisholm brushed a finger against the blue incandescent glow of her computer screen. “This patient is a 48-year-old female who had a kidney transplant about eight months ago,” she said, pausing at the medical profile of the faceless woman.

Mrs. Johnson is one of many: Each year in the United States, more than 13,500 patients undergo kidney transplants, often a result of kidney failure caused by hypertension and diabetes. Drug therapy for these patients is long-term and intense. That’s where Chisholm comes in.

As both an associate professor of pharmacy at the UGA College of Pharmacy and associate professor of medicine at the Medical College of Georgia, Chisholm understands the trade-off inherent in post-transplant medicines.

“Just like in some economics classes where you learn there’s no free lunch, well, there’s no free lunch here,” Chisholm said.

To prevent rejection of the new organ, patients take drugs to suppress the body’s immune system. Although these drugs are imperative for a successful transplant, they also present an onslaught of new problems. With a suppressed immune system the body is susceptible to infectious disease; the drugs also can exacerbate the pre-existing conditions of hypertension and diabetes.

“You have this delicate balance and you try to minimize the adverse effects,” Chisholm said, “whether it’s rejection of the transplanted organ, infectious disease or increasing the risk of developing high blood pressure, hypertension or high blood glucose.”

To maintain that balance, careful pharmacotherapy is a priority.

In her hands, Marie Chisholm holds the average daily medication requirements for a kidney transplant patient. “Therapy alone is more than $25,000 a year. That’s more than $2,000 a month — 70 bucks a day. Financially it’s tough,” Chisholm said.

“I’m a clinical pharmacist by training,” Chisholm said, explaining the difference from the dispensing role of the retail pharmacist. The clinical pharmacist collects and uses patient data to recommend and monitor therapy.

Chisholm and her colleagues conducted an 18-month study from 1997 to 1999 to determine the impact of a clinical pharmacist on organ-transplant success. During the trial, patients were divided into two groups: Both groups received traditional care, but one group interacted with a clinical pharmacist also. The clinical pharmacist’s duties ranged from medication reviews, monitoring therapy, and encouraging patient compliance, to increasing patient access to medications.

Chisholm found that clinical pharmacist care could decrease adverse reactions to medications by patients while increasing drug compliance and blood pressure control. From an economic stand-point, interaction with a clinical pharmacist also decreased hospital stays and cost, which is often a major issue for transplant patients.

For example, Chisholm pointed to Mrs. Johnson’s drug list.

“Mrs. Johnson has a medical history of end-stage renal disease,” Chisholm said, “but she also has hypertension, diabetes, a history of depression and high cholesterol. She’s taking more than 30 different units of medicine a day.”

Mrs. Johnson isn’t alone. Most transplant patients not only take immunosuppressants, but also take drugs for pre-existing conditions. These medications are extremely expensive — finances can have a negative impact on patient health.

“Mrs. Johnson’s therapy alone is more than $25,000 a year. That’s more than $2,000 a month — 70 bucks a day. Financially it’s tough,” Chisholm said.

A major cause of graft rejection and transplant failure is patient noncompliance — not taking prescribed medications. Many things cause a patient to fail to take medication properly: cost, confusion, lack of appropriate instructions, complicated drug regimens or failure to obtain medication. The services of a clinical pharmacist can mitigate these factors.

Many pharmaceutical companies sponsor assistance programs, providing medications free or at reduced prices for patients in need. Clinical pharmacists can educate patients, about programs they are eligible for. “Medicine is not only diagnosing and writing a prescription,” Chisholm said, “it involves social issues and issues concerning education.”

In October 1999, Chisholm, with the financial support of the Carlos and Marguerite Mason trust fund, founded the Medication Access Program. Administered by a small group of UGA College of Pharmacy faculty and staff, and directed by Chisholm, MAP’s mission is to increase access to medications for solid organ transplant patients in Georgia. MAP educates patients and healthcare professionals about medication assistance programs. It also helps patients complete applications and enroll in these programs. In the past two years, it has helped more than 180 Georgians acquire more than $1.6 million of medication.

“One of the most gratifying parts of my job is that I see the difference. I’m looking at that patient and I know what I did made a difference,” Chisholm said with a smile. “They actually turn around and say thank you and shake your hand. You feel good about that.”

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Research Communications, Office of the VP for Research, UGA
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