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

Noah Zlotnik; Angelina Abbaticchio; Madeline Theodorlis; Michelle S Cross; Abhijat Kitchlu; Jo-Anne Wilson; Anna R Gagliardi; Marisa Battistella

doi:10.34067/KID.0000000884

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

Kidney360. 2025 Jun 26. doi: 10.34067/KID.0000000884. Online ahead of print.

Authors

Noah Zlotnik^{1

2}, Angelina Abbaticchio², Madeline Theodorlis², Michelle S Cross², Abhijat Kitchlu^{3

4}, Jo-Anne Wilson^{5

6}, Anna R Gagliardi⁷, Marisa Battistella^{1

2}

Affiliations

¹ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
² Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
³ Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
⁴ Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada.
⁵ Faculty of Health, College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
⁶ Nova Scotia Health Research and Innovation, Halifax, Nova Scotia, Canada.
⁷ Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.

PMID: 40569679
DOI: 10.34067/KID.0000000884

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.