Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

Area of Science:

• Nephrology
• Psychiatry
• Clinical Pharmacy

Background:

• Hemodialysis (HD) is the primary treatment for chronic kidney failure (CKF), affecting millions globally.
• Patients undergoing HD report reduced quality of life, with high rates of depression and anxiety.
• Increasing patient age and comorbidities contribute to cognitive impairment and complex mental health needs.

Purpose of the Study:

• To review psychotropic medication use in CKF patients undergoing HD.
• To explore altered pharmacokinetics of these medications due to kidney replacement therapy (KRT).
• To discuss polypharmacy, drug interactions, and deprescribing strategies for this population.

Main Methods:

• This narrative review synthesizes current literature on psychotropic drug management in CKF patients.
• It examines pharmacokinetic changes and clinical implications of medication use in HD.
• Focus is placed on identifying challenges and solutions, including deprescribing.

Main Results:

• CKF patients on HD frequently require psychotropic medications for mental health comorbidities.
• Renal impairment significantly alters drug elimination, affecting efficacy and safety.
• Polypharmacy and drug interactions are common, necessitating careful management.

Conclusions:

• Optimizing psychotropic medication use in HD patients requires understanding altered pharmacokinetics.
• Deprescribing algorithms are crucial for managing polypharmacy and improving patient outcomes.
• Integrated care addressing both kidney function and mental health is essential.