Zidan Amani, ElGeed Hager, Alsalemi Noor, Hamad Abdullah, Ibrahim Rania, Stewart Derek, Awaisu Ahmed
College of Pharmacy, QU-Health Sector, Qatar University, Doha, Qatar.
Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
Res Social Adm Pharm. 2025 Sep;21(9):679-686. doi: 10.1016/j.sapharm.2025.05.005. Epub 2025 May 9.
Chronic kidney disease (CKD) is a major global health concern that is associated with multiple complications and comorbidities, leading to polypharmacy, inappropriate prescribing, and increased risk of adverse drug events. Deprescribing has emerged as an effective strategy to mitigate these consequences. Evidence-based guidelines are essential to support appropriate deprescribing practices in this population. A variety of deprescribing tools and guidelines are now widely available, but little is known about their utility in CKD setting. This study aimed to identify and characterize published deprescribing tools and guidelines specifically designed for patients with CKD.
A comprehensive search of PubMed, EMBASE, Cochrane Library, guidelines registries, and international deprescribing networks was conducted up to December 2024. Records were included if they presented a tool or guideline for deprescribing in patients with CKD. After removing duplicates, titles and abstracts were screened, followed by full-text reviews conducted using Rayyan® AI Software.
Of the 257 full-text records assessed, 11 met the eligibility criteria, detailing the development of 10 deprescribing tools and guidelines in CKD. These were categorized into four types: (1) comprehensive deprescribing process guidance (n = 2); (2) protocols for comprehensive deprescribing care models (n = 2); (3) drug-specific deprescribing algorithms (n = 4); and (4) screening tools for specific deprescribing steps (n = 2). The development methods of the tools varied: two tools combined literature reviews with expert consensus, four were based on literature reviews alone, three employed pre-determined systematic development frameworks, and the remaining tool was an individualized electronic decision-support tool. Several tools had undergone validation (n = 3) or pilot testing (n = 4) in various clinical settings.
This review identified and characterized the existing tools and guidelines for deprescribing in CKD, suggesting a limited but diverse body of resources. This review highlights the need for more robust, evidence-based deprescribing tools development that is tailored to the complex needs of CKD populations.
慢性肾脏病（CKD）是一个重大的全球健康问题，与多种并发症和合并症相关，导致多重用药、处方不当以及药物不良事件风险增加。减药已成为减轻这些后果的有效策略。循证指南对于支持该人群的适当减药实践至关重要。现在有多种减药工具和指南广泛可用，但对于它们在CKD环境中的效用知之甚少。本研究旨在识别和描述专门为CKD患者设计的已发表的减药工具和指南。
截至2024年12月，对PubMed、EMBASE、Cochrane图书馆、指南注册库和国际减药网络进行了全面检索。如果记录呈现了针对CKD患者减药的工具或指南，则将其纳入。去除重复记录后，筛选标题和摘要，然后使用Rayyan®人工智能软件进行全文审查。
在评估的257条全文记录中，11条符合纳入标准，详细介绍了10种CKD减药工具和指南的开发情况。这些被分为四种类型：（1）全面的减药过程指导（n = 2）；（2）全面减药护理模式的方案（n = 2）；（3）特定药物的减药算法（n = 4）；以及（4）特定减药步骤的筛查工具（n = 2）。这些工具的开发方法各不相同：两种工具将文献综述与专家共识相结合，四种仅基于文献综述，三种采用预先确定的系统开发框架，其余一种是个性化的电子决策支持工具。几种工具已在各种临床环境中进行了验证（n = 3）或试点测试（n = 4）。
本综述识别并描述了现有的CKD减药工具和指南，表明资源有限但种类多样。本综述强调需要针对CKD人群的复杂需求开发更强大、基于证据的减药工具。
