ABSTRACT
OBJECTIVE：To provide referenc e for developing pharmaceutical care of chronic kidney disease （CKD）by clinical pharmacists. METHODS ：During 1st，Jan. to 30th，Sept. in 2019，inpatients diagnosed as CKD admitted or transferred to nephrology department of our hospital were selected. Medication reconciliation was conducted by clinical pharmacists after pharmaceutical consultation ，reviewing medical records ，analyzing and summarizing drug-related problem （DRP）. Medication reconciliation recommendations were proposed to physician. Subsequently ，drug list and medical education were provided to patients by clinical pharmacists. RESULTS & CONCLUSIONS ：The medication information of 130 patients was collected ，and 85 of them were provided with medication reconciliation by clinical pharmacist ，with a reconciliation rate of 65.38％. There were 193 medical orders involved 85 patients. Among all the DRP ，the top three of proportion in medical orders were improper drug usage and dosage （41.96％），drug interactions （18.13％）and improper drug selection （14.51％）. Among drugs related to medication reconciliation，top three types were cardiovascular system drugs （26.94％），drug correcting mineral and bone metabolism disorder （22.28％）and antibacterial drugs （16.02％）. The main plans of medication reconciliation were drug change （71 cases，36.78％）， drug withdrawal （42 cases，21.76％），drug supplement （35 cases，18.13％），followed by change of medication time and dosage adjustment. The majority （88.08％）of the recommendations were accepted by physician and patients. Clinical pharmacists can reduce the occurrence of DRP by medication reconciliation. The majority of patients with CKD were elderly and complicated with multiple diseases and took various drugs ，and part of drugs required dose adjustment due to the change of kidney function ，therefor clinical pharmacists implementing medication reconciliation to CKD ，should pay attention to drug usage and dosage ，especially disorder，and assist physicians to ensure safety of drug use in