Medication-related harm is a significant challenge globally. As so many medicines are excreted renally, risk of harm is increased in renal impairment and chronic kidney disease (CKD). CKD affects 100 million Europeans, costing €140 billion annually. CKD occurs organically or because of medication-related harm, and increases susceptibility to further harm, to the kidneys and more generally. Many medications require deprescribing (dose reduction, stopping, or substitution) to avoid medication-related harm. Despite its importance, there is little evidence and lack of guidance on identifying medications to consider deprescribing for patients with CKD in primary care.
This project aims to (1) develop a comprehensive set of indicators to guide medicines optimisation and deprescribing in people with CKD in primary care, and (2) understand the opportunities for, occurrence of, and process of deprescribing for people with CKD in primary care.
This will be achieved through five studies across three work-packages. Study-1 is a scoping review of current evidence/recommendations on medications to deprescribe for patients with CKD in primary care. Study-2 is a modified Delphi study to achieve expert consensus on a comprehensive set of indicators to identify potentially inappropriate prescribing and guide deprescribing in patients. Study-3 is a cohort study using linked routine primary care data from England (Clinical Practice Research Datalink) to apply the indicators to, to establish the prevalence of potentially inappropriate prescribing. Study-4 will use the same data source and will assess the occurrence of deprescribing of potentially inappropriate and other medicines for CKD patients, and will establish how and in what circumstances deprescribing occurs routinely. Study-5 is a qualitative study of general practitioners and pharmacists, to understand their current practice and perceptions of deprescribing for patients with CKD in primary care.
This project will enhance understanding of safe medicines use in CKD, and enable targeted interventions to improve medication safety.