Medication review interventions for adults living with advanced chronic kidney disease: A scoping review

Abstract

Structured medication reviews (SMRs) were introduced into the National Health Service (NHS) Primary Care to support the delivery of the NHS Long-Term Plan for medicines optimization. SMRs improve the quality of care, reduce harm and offer value for money. However, evidence to support SMRs for patients with chronic kidney disease (CKD) stage G4-5D with elevated risk of cardiovascular disease and premature mortality is unknown. This scoping review aimed to assess the extent and nature of SMR research in the population of patients with CKD stage G4-5D. Electronic databases were searched on 20 October 2023. Studies were eligible if they described an SMR in adults with CKD stage G4-5D, regardless of the study design. Data detailing the global patterns, population and intervention descriptions, professionals performing SMR, and reported areas for future research were extracted. The extracted outcome data were categorized as clinical, patient-important, medication-related and experience-related. A narrative synthesis was completed. Seventeen studies (81%) were conducted in nephrology outpatient settings, three (14%) during acute hospital admissions and one (5%) within the community pharmacy. Eighteen studies (86%) were quantitative, including five randomized controlled trials. Ten (48%) studies were undertaken in the United States and Canada, and two in Europe (France and Norway). No such studies have been conducted in the United Kingdom. Our review revealed that there is a lack of evidence for SMR as a strategy to reduce polypharmacy and harms from medication for adults with CKD stage G4-5D. Therefore, further research is required in this area.

Keywords: adverse drug reactions; co‐morbidity; deprescribing; medicines optimisation; morbidity.

FIGURE 1

PRISMA‐ScR flow diagram illustrating the study identification, screening and inclusion process.

FIGURE 2

A global map of medication review studies for people living with CKD stage G4‐5D.

FIGURE 3

A butterfly chart showing the medication review studies by their aim, style and the professional undertaking them.

FIGURE 4

Venn diagram of outcomes measured in medication review studies for CKD stage G4‐5D patients.