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Development and Validation of Nine Deprescribing Algorithms for Patients on Hemodialysis to Decrease Polypharmacy.

Melissa J Lefebvre1, Patrick C K Ng1, Arlene Desjarlais2

  • 1Department of Pharmacy, University Health Network, Toronto, ON, Canada.

Canadian Journal of Kidney Health and Disease
|November 16, 2020
PubMed
Summary
This summary is machine-generated.

Deprescribing algorithms for hemodialysis patients were developed to reduce polypharmacy. These validated, medication-specific guidelines offer a patient-centric approach for safer medication management in this population.

Keywords:
chronic kidney diseaseclinical tool developmentdeprescribinghemodialysispolypharmacy

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Area of Science:

  • Nephrology
  • Clinical Pharmacology
  • Medication Safety

Background:

  • Polypharmacy is common in hemodialysis (HD) patients, increasing risks of adverse events and mortality.
  • Existing deprescribing guidelines lack specific instructions for nephrology clinicians.
  • There is a need for tailored deprescribing strategies in HD populations.

Purpose of the Study:

  • To develop and validate deprescribing algorithms for nine medication classes.
  • To reduce polypharmacy in patients undergoing hemodialysis.
  • To provide nephrology clinicians with practical tools for medication management.

Main Methods:

  • Algorithms developed using Lynn's method for content-valid clinical tools.
  • Validated through three rounds of interviews with 45 Canadian nephrology practitioners.
  • Clinicians rated algorithm components for relevance and face validity using Likert scales.

Main Results:

  • Nine medication-specific deprescribing algorithms were developed.
  • All nine algorithms achieved content validity after iterative review and revision.
  • High clinician agreement (84%-95%) on face validity statements across all algorithms.

Conclusions:

  • Validated deprescribing algorithms for nine medication classes in HD patients have been created.
  • These represent the first medication-specific, patient-centric deprescribing guidelines for HD populations.
  • The developed algorithms can aid clinicians in minimizing polypharmacy risks.