Research Awards Recipients

General Audience Summary

Patients on hemodialysis (HD) take more pills per day on average than any other chronically ill patient population. On average, a patient on HD takes 15 medications per day, of which 70% may not be appropriate. The medications may not be appropriate because patients on HD are rarely included in clinical trials for new medications, and therefore the efficacy and safety data that exists for the general population may not actually apply to them. Tools to guide the re-assessment and discontinuation (deprescribing) of these specific medications that lack evidence for efficacy and safety in patients on HD are needed. These tools will help reduce the number of medications being taken and may also reduce the potential negative consequences of taking so many medications (e.g. adverse drug reactions, drug-drug interactions, non-adherence, increased risk of cognitive impairment, impaired balance and falls, and increased risk of hospitalization, and mortality). Our study group identified nine medications that are often inappropriately prescribed to patients on HD. These medications are: Alpha-1 Blockers, Benzodiazepines & Z-Drugs, Gabapentinoids, Loop Diuretics, Prokinetic Agents, Proton Pump Inhibitors, Quinine, Statins, and Urate Lowering Agents. We developed and validated tools to help medical teams and patients in outpatient HD units with identifying and stopping these medications. The next step for our working group will be to perform a study where we test these tools in practice at an HD centre in Toronto. We believe that this study will help decrease the number of medications per patient and decrease inappropriate medication use in the HD unit. The results of this study will help us make improvements to our deprescribing tools that will make them easy-to-use and adaptable to all patients. The goal of this study is to improve patient experiences by optimizing medication use and prescribing patterns in HD units across Canada.