When patients begin treatment at the Waterloo Wellington Regional Renal Program at Waterloo Regional Health Centre (WRHN), hemodialysis quickly becomes part of their weekly routine. For many, it means spending several hours in treatment multiple times a week and managing a complex set of medications.
University of Waterloo School of Pharmacy alum Keith Miller (BScPhm’11, PharmD’16) supports these patients as a pharmacist in WRHN’s outpatient hemodialysis program. He works closely with patients living with end-stage renal disease to ensure their medications are safe, effective and aligned with their goals of care.
“Supporting patients on dialysis requires careful monitoring and quick intervention when something changes,” Miller says. “Our goal is to make sure our patients receive the right care so they feel confident managing their health.”
Patients receiving hemodialysis often take a high number of medications to manage conditions such as anemia, diabetes and cardiovascular disease. Some may take more than a dozen medications, up to 30 tablets a day, making treatment difficult to manage.
Medication management can be overwhelming, especially for dialysis patients. If we can simplify that, help patients understand their treatments and support them, we can make a meaningful difference in their lives.
Miller and the pharmacy team regularly review these medications, adjust doses and deprescribe those that are no longer needed while introducing new therapies where appropriate. As a result, patients can better manage their symptoms with a simplified medication routine while meeting their goals.
“You’re not just making a recommendation and hoping it works. You’re able to follow up, adjust and really see the impact of your care,” he says. “Patients in this program are incredibly resilient; they’re managing a chronic condition full-time on top of their other responsibilities.”
This model of care helps prevent additional hospital admissions, reduce medication-related complications and improve overall patient outcomes. As a key contributor to the program, Miller not only adjusts medications, but he provides patient education and collaborates with physicians, nurses, dieticians and other healthcare professionals to deliver continuity of care. This collaborative approach is essential, where all healthcare providers contribute to the broader care plan, including students.
The School’s emphasis on experiential learning and adaptability continues to influence Miller’s work. He regularly mentors pharmacy students during their clinical patient care rotations, offering the same hands-on learning experiences that helped define his own career.
“It’s an opportunity to not only teach clinical skills but also model how to approach patient care thoughtfully and collaboratively,” he says. “In turn the students push me to keep learning in our ever-evolving field.”
As healthcare systems continue to evolve, Miller sees a growing demand for specialized pharmacy roles, particularly in complex areas like nephrology where evidence-based treatment can be limited and treatment decisions require careful interpretation and patient-centred judgement.
He is also interested in improving how patient information is shared across care teams to reduce gaps during transitions between hospital and outpatient care — a critical factor in patient safety and reducing re-admissions.
“Medication management can be overwhelming, especially for dialysis patients,” he says. “If we can simplify that, help patients understand their treatments and support them, we can make a meaningful difference in their lives.”
The University of Waterloo School of Pharmacy and WRHN have been long-standing partners, working together to bridge education and real-world practice in support of improved patient care.