Keeping it renal

Outside his usual kidney care, renal pharmacist Lindon Clark can be found hiking and climbing around Queensland.

Why choose pharmacy?

I started my first year of university in medical sciences, but came to the realisation I’d prefer a more social role. With a passion to empower people to take the initiative, health care is a perfect place for this with varying levels of communication styles, patient backgrounds and complexities.

The profession is an ongoing learning experience that keeps me feeling challenged, with pharmacist roles now beginning to expand beyond clinical and operational positions into project and digital work.

How did you wind up specialising as a renal pharmacist?

Through years of practice as a generalist hospital pharmacist working across multiple specialities including renal, digital health care, cardiovascular, cancer and blood disorders across inpatient and outpatient settings.

I chose specialisation in renal care, because when we go back to pharmacokinetics the kidney is such a paramount organ as it influences medicine choice, dose and frequency.

As the patient progresses into renal replacement it adds other complexities such as medication dialysability.

Tell us about your role?

It involves medication advice and care of acute and non-acute patients across the renal spectrum. I collaborate closely with renal physicians and the multidisciplinary team including nursing, psychology, dietetics, social work, nurse navigator, and podiatry to maximise patient care.

I also work with the patient in a joint decision-making capacity to allow ongoing engagement and encouragement to optimise medication management and adherence.

Another part involves communicating with local community providers such as general practitioners and pharmacies who may be less familiar with dialysis considerations and renal impairment-related medication considerations such as medication choice and dose to optimise patient care.

Are pathology results a mainstay of your role?

Pathology is an essential component of optimising patient care, whether it be assisting medicine-related decisions based on patient parameters or improving symptom management such as anaemia.

It’s also a great tool to determine medication compliance and start a conversation. Renal patients are normally heavily burdened with over-prescribing practices, so the use of pathology results plays a crucial role for the pharmacist.

Pathology also influences interventional surgical procedures required for patients such as an arteriovenous fistula or parathyroidectomy.

Once a procedure is scheduled, it introduces another potential for medication management in advance.

In chronic kidney disease, we commonly need to take into consideration pathology such as estimated glomerular filtration rate, haemoglobin, potassium, bicarbonate, calcium, parathyroid hormone and alkaline phosphatase. This allows prescription optimisation and intervention across all dialects of chronic kidney disease. 

What’s the most satisfying part of your role?

Renal disease can be a complex and deleterious cycle of events. But working with the patient through their journey with my amazing team is incredibly rewarding – whether that’s building a trust relationship to work towards a transplant or palliation.

Consistency is a valuable aspect of the patient experience.

I am passionate about symptom management support as I’m a fond believer in quality of life, joint decision making and patient advocacy.

Would you recommend this path to other early career pharmacists?

Before specialisation anywhere, I would strongly recommend getting a good generalist foundation. So many organs and disease conditions interrelate. It also depends on where interests lie.

Overall, my time within the renal space has been invaluable. Within such a chronic population I find it extremely holistic. We don’t just see a patient in a snapshot in time.