Deprescribing tools and guidelines in chronic kidney disease: A scoping review

Abstract

BackgroundChronic 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. MethodsA 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. ResultsOf 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. ConclusionsThis 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.