Prescribing and deprescribing in chronic kidney disease

Area of Science:

• Nephrology
• Clinical Pharmacy
• Pharmacology

Background:

• Chronic kidney disease (CKD) frequently co-exists with other conditions, leading to multimorbidity.
• Consequently, patients with CKD often manage multiple medications (polypharmacy).
• Some medications are crucial for managing cardiovascular disease (CVD) risk and slowing CKD progression, while others may necessitate dose adjustments or discontinuation as CKD advances.

Purpose of the Study:

• To outline key principles for managing the complexities and requirements of polypharmacy in patients with CKD.

Main Methods:

• Review of current literature and clinical guidelines on medication management in CKD.
• Discussion of medication classes beneficial for CVD risk reduction and CKD progression.
• Exploration of strategies for medication review and deprescribing.

Main Results:

• Certain medications (e.g., ACE inhibitors, ARBs, statins, SGLT-2 inhibitors) offer benefits for CVD risk and CKD progression, requiring careful benefit-risk assessment.
• Dose reduction or cessation of specific medications is vital to prevent adverse events, drug accumulation, and kidney injury.
• Collaborative approaches, including Home Medicines Reviews and deprescribing tools, are effective in managing polypharmacy.

Conclusions:

• Effective management of polypharmacy in CKD involves a nuanced approach to medication selection and adjustment.
• Shared decision-making and deprescribing tools are essential for optimizing medication regimens and patient safety in CKD.
• Balancing therapeutic benefits with the risks of adverse events and kidney injury is paramount in polypharmacy management for CKD patients.