Medication Mindfulness: Implementation and Evaluation of a Single-Site, 6-month Deprescribing Intervention for Patients on Hemodialysis.

Abstract

Background: Patients on hemodialysis (HD) are at increased risk for polypharmacy-related adverse events (AEs). Deprescribing may optimize medication use and mitigate the harmful effects of polypharmacy, but its application in patients on HD remains understudied. The overall aim of this study is to implement and evaluate the effectiveness and safety of a deprescribing intervention utilizing a deprescribing toolkit in multiple HD units across Canada. This preliminary study aims to demonstrate the efficacy and safety of the intervention within one HD unit in Toronto, Canada.

Methods: This single-center study included patients on HD for at least three months who were taking at least one of nine study medication classes. Clinicians applied deprescribing algorithms to determine if deprescribing was recommended. Clinicians and patients could decline the algorithm's recommendation. Primary outcomes include the number of patients successfully deprescribed by discontinuing or reducing the dose of their medication over 6 months, and clinically significant AEs. Secondary outcomes include clinician and patient acceptance of algorithm recommendations, and clinical monitoring.

Results: Ninety-eight patients were taking an average of 13.47 (+4.01) medications, with an average of 2.32 (+1.00) being study medications. The algorithms recommended 40 patients to deprescribe 49 study medications. Clinicians agreed to 39 (80%) recommendations, and patients agreed to 28 of those 39 (72%). Twenty patients successfully deprescribed 23 medications (82%), while 5 patients failed and restarted 5 medications (18%) at their baseline dose. Clinical monitoring and spontaneous reporting revealed no AEs considered related to the intervention.

Conclusions: Approximately 1 in 5 eligible patients successfully deprescribed a medication with minimal clinical detriment. While the deprescribing algorithms are valuable in guiding clinical decision-making, final decisions rest with clinicians, constituting a careful synthesis of potential benefits, risks, and goals of care for each individual patient. Future research will analyze deprescribing outcomes at additional HD units in Canada.