Drug Stewardship in CKD

Multimorbidity and polypharmacy are common among patients with chronic kidney disease (CKD). Drug stewardship to ensure the safety and effectiveness of medications is especially important in this population, since kidney dysfunction can affect the pharmacokinetics and pharmacodynamics of medications, and thus their risks and benefits. The scope of these changes for all medications and situations is not well known.  

Drug stewardship is achieved through processes, including medication selection, medication reconciliation, dose adjustment, observation of effectiveness and safety, and deprescribing medications when no longer necessary.  

Rasheeda K. Hall, MD, and others conducted a review to help optimize drug stewardship for patients with CKD. They noted that doses for patients with CKD should be adjusted based on estimated glomerular filtration rate (eGFR), but there are other patient circumstances requiring special considerations for medication use. These circumstances include pregnancy and lactation, acute illness, and cancer. They also described guidance for use of over-the-counter drugs, herbal remedies, supplements, and sick-day rules. Hall et al emphasized global inequities in access to medication and possible policy solutions to address them.  

In sum, the researchers recommended patient education and engagement, the use of digital health tools, shared decision-making, and collaboration within interdisciplinary teams as ways to advance drug stewardship among patients with CKD. 

Source: Nature Reviews Nephrology