Prescribing and deprescribing in chronic kidney disease

Chronic kidney disease (CKD) rarely occurs in isolation; multimorbidity is the norm. As a result, polypharmacy is common in people with CKD. Some medications are indicated to reduce the risk of cardiovascular disease and progression of CKD. In contrast, some medications may require dose reduction or cessation as a result of advancing stages of CKD.

The aim of this article is to describe broad principles of managing the challenges and necessities of polypharmacy in patients with CKD.

Medications such as angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins and sodium-glucose co-transporter-2 inhibitors may reduce cardiovascular disease risk and/or reduce CKD progression, and their use should be balanced by likelihood of benefit. Medication cessation or dose reduction may be required to prevent medication accumulation, adverse medication events and kidney injury. Polypharmacy can be addressed with a collaborative Home Medicines Review and use of deprescribing tools, using a shared decision-making approach.