Polypharmacy in chronic kidney disease: Health outcomes & pharmacy-based strategies to mitigate inappropriate polypharmacy

IfeanyiChukwu O Onor; Fahamina Ahmed; Anthony N Nguyen; Michael C Ezebuenyi; Collins Uchechukwu Obi; Alison K Schafer; Amne Borghol; Erwin Aguilar; John I Okogbaa; Efrain Reisin

doi:10.1016/j.amjms.2023.10.003

Polypharmacy in chronic kidney disease: Health outcomes & pharmacy-based strategies to mitigate inappropriate polypharmacy

Am J Med Sci. 2024 Jan;367(1):4-13. doi: 10.1016/j.amjms.2023.10.003. Epub 2023 Oct 12.

Authors

Affiliations

¹ College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA; Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA. Electronic address: ionor@lsuhsc.edu.
² College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; East Jefferson General Hospital-Family Medicine Clinic, Metairie, LA, USA.
³ Department of Pharmacy, Ochsner Health System, Jefferson, LA, USA.
⁴ Department of Pharmacy, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.
⁵ Medical Laboratory Science Department, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria.
⁶ Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.
⁷ College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA; Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA.
⁸ Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.
⁹ College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.

PMID: 37832917
DOI: 10.1016/j.amjms.2023.10.003

Abstract

The rising prevalence of comorbidities in an increasingly aging population has sparked a reciprocal rise in polypharmacy. Patients with chronic kidney disease (CKD) have a greater burden of polypharmacy due to the comorbidities and complications associated with their disease. Polypharmacy in CKD patients has been linked to myriad direct and indirect costs for patients and the society at large. Pharmacists are uniquely positioned within the healthcare team to streamline polypharmacy management in the setting of CKD. In this article, we review the landscape of polypharmacy and examine its impacts through the lens of the ECHO model of Economic, Clinical, and Humanistic Outcomes. We also present strategies for healthcare teams to improve polypharmacy care through comprehensive medication management process that includes medication reconciliation during transitions of care, medication therapy management, and deprescribing. These pharmacist-led interventions have the potential to mitigate adverse outcomes associated with polypharmacy in CKD.

Keywords: Chronic kidney disease; Comprehensive medication management; Deprescribing; Medication therapy management; Polypharmacy.

Publication types

Review

MeSH terms

Aged
Humans
Inappropriate Prescribing / prevention & control
Outcome Assessment, Health Care
Pharmacists
Pharmacy*
Polypharmacy
Renal Insufficiency, Chronic* / drug therapy