Development and Validation of Consensus-Based Deprescribing Algorithms for Patients with Chronic Kidney Disease

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Development and Validation of Consensus-Based Deprescribing Algorithms for Patients with Chronic Kidney Disease

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Co-author 1

Abdullah Hamad AHamad9@hamad.qa Hamad Medical Corporation Medicine Doha Qatar *

Co-author 2

Amani Zidan az1405317@student.qu.edu.qa Qatar University of Pharmacy Pharmacy Doha Qatar -

Co-author 3

Kheloud Awad KAwad3@hamad.qa Hamad Medical Corporation Pharmacy Doha Qatar -

Co-author 4

Safeya Hbib V-SHbib@hamad.qa Hamad Medical Corporation Pharmacy Doha Qatar -

Co-author 5

Noor alsalemi noor.alsalemi@qu.edu.qa Qatar University of Pharmacy Pharmacy Doha Qatar -

Co-author 6

Hager El-Geed h.elgeed@qu.edu.qa Qatar University of Pharmacy Pharmacy Doha Qatar -

Co-author 7

MOHAMED ELESNAWI MELESNAWI@hamad.qa Hamad Medical Corporation Medicine Doha Qatar -

Co-author 8

Fatima El Tayeb FElTayeb@hamad.qa Hamad Medical Corporation Medicine Doha Qatar -

Co-author 9

Rania Ibrahim RIbrahim4@hamad.qa Hamad Medical Corporation Nursing Doha Qatar -

Co-author 10

Hassan Al-Malki halmalki1@hamad.qa Hamad Medical Corporation Medicine Doha Qatar -

Co-author 11

Ahmed Awaisu aawaisu@qu.edu.qa Qatar University of Pharmacy Pharmacy Doha Qatar -

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Patients with chronic kidney disease (CKD) are often treated with multiple medications, leading to polypharmacy, which may be inappropriate. Deprescribing has emerged as a proactive intervention to address the risks associated with inappropriate polypharmacy. Evidence-based tools and guidelines are crucial to enhance healthcare providers' ability to deprescribe effectively. While several deprescribing tools and guidelines exist for several populations of patients, their utility in CKD settings remains limited.

Methods

A nominal group technique was used as a consensus development methodology to adapt existing tools and create comprehensive deprescribing algorithms for CKD patients. A panel of five experts in pharmacotherapy, medication safety, and clinical research was assembled. After gathering evidence on deprescribing practices for CKD patients, we conducted multiple rounds of meetings to review this evidence and develop deprescribing algorithms. Once consensus was achieved, the adapted algorithms were documented and subsequently reviewed by nephrology consultants for further validation. The algorithms were then utilized in a pilot deprescribing study to test their utility in this setting. This study was supported and funded by the Medical Research Center (MRC), Hamad Medical Corporation, Internal Research Grant (MRC-01-22-314).

Results

Nineteen evidence-based deprescribing algorithms were developed, comprising one general and 18 drug class-specific algorithms that are frequently prescribed in CKD care. These comprehensive algorithms were designed to assess the appropriateness of prescribed medications and facilitate a structured deprescribing process. Validation by experts and pilot testing further refined the algorithms, underscoring their usability and convenience.

Conclusion

We produced evidence-based deprescribing algorithms tailored for CKD patients, offering a structured approach to identifying and deprescribing potentially inappropriate medications.

Kewords