Medications for community pharmacists to dose adjust or avoid to enhance prescribing safety in individuals with advanced chronic kidney disease: a scoping review and modified Delphi

• Published in: BMC nephrology 2024-10, Vol.25 (1), p.386-10, Article 386
• Main Authors: Wilson, Jo-Anne, Ratajczak, Natalie, Halliday, Katie, Battistella, Marisa, Naylor, Heather, Sheffield, Maneka, Marin, Judith G, Pitman, Jennifer, Kennie-Kaulbach, Natalie, Trenaman, Shanna, Gillis, Louise
• Format: Article
• Language: English
• Subjects: Analysis; Cancer therapies; Care and treatment; Chronic Kidney Disease; Chronic kidney failure; Ciprofloxacin; Community Pharmacy Practice; Community Pharmacy Services; Comorbidity; Delphi Technique; Diagnosis; Dialysis; Drug dosages; Drug stores; Drug therapy; Education; Epidermal growth factor receptors; Gabapentin; Geriatrics; Glomerular Filtration Rate; Grey literature; Hemodialysis; Humans; Inappropriate Prescribing - prevention & control; Kidney diseases; Medication Safety; Metformin; Nephrology; Nitrofurantoin; Nonsteroidal anti-inflammatory drugs; Patient outcomes; Pharmacists; Polypharmacy; Practice; Prescription writing; Prevention; Primary care; Renal Insufficiency, Chronic - drug therapy; Reviews; Risk factors
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-024-03829-y

Community pharmacists commonly see individuals with chronic kidney disease (CKD) and are in an ideal position to mitigate harm from inappropriate prescribing. We sought to develop a relevant medication list for community pharmacists to dose adjust or avoid in individuals with an estimated glomerular filtration rate (eGFR) below 30 mL/min informed through a scoping review and modified Delphi panel of nephrology, geriatric and primary care pharmacists. A scoping review was undertaken to identify higher risk medications common to community pharmacy practice, which require a dose adaptation in individuals with advanced CKD. A 3-round modified Delphi was conducted, informed by the medications identified in our scoping review, to establish consensus on which medications community pharmacists should adjust or avoid in individuals with stage 4 and 5 CKD (non-dialysis). Ninety-two articles and 88 medications were identified from our scoping review. Of which, 64 were deemed relevant to community pharmacy practice and presented for consideration to 27 panel experts. The panel consisted of Canadian pharmacists practicing in nephrology (66.7%), geriatrics (18.5%) and primary care (14.8%). All participants completed rounds 1 and 2 and 96% completed round 3. At the end of round 3, the top 40 medications to adjust or avoid were identified. All round 3 participants selected metformin, gabapentin, pregabalin, non-steroidal anti-inflammatory drugs, nitrofurantoin, ciprofloxacin and rivaroxaban as the top ranked medications. Medications eliminated by the kidneys may accumulate and cause harm in individuals with advanced chronic kidney disease. This study provides an expert consensus of the top 40 medications that community pharmacists should collaboratively adjust or avoid to enhance medication safety and prescribing for individuals with an eGFR below 30 mL/min.