Deprescribing for Older Dialysis Patients

Duke University

Status: Completed

Conditions: Kidney Failure, Chronic

Treatments: Behavioral: Deprescribing Intervention

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT03631290

1K76AG059930 (U.S. NIH Grant/Contract)

Pro00100184

Details and patient eligibility

About

Aim 1 of the study is to identify the elements of a deprescribing intervention that address contextual factors specific to dialysis.

Aim 2 of the study, described in this record, is to determine the feasibility of a deprescribing intervention tailored for older dialysis patients.

Older adults receiving dialysis are often prescribed multiple medications. Some of these medications are used to treat symptoms, but they also can increase the chance of significant health problems. The purpose of this study is to identify if it is feasible to reduce the use of medications that have been identified as causing an increased risk for health problems.

Enrollment: 48 patients

Sex: All

Ages: 55+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria (patients):

• an adult receiving dialysis for at least 6 months
• at least one active prescription for a potentially inappropriate medication (gabapentinoids, clonidine, alpha blockers, muscle relaxants, and Z-drugs)

Exclusion Criteria (patients):

• advanced dementia
• hospice care
• non-English speaking

Inclusion Criteria (providers):

• must be employed by Duke
• must see patients at a Duke affiliated DaVita hemodialysis (HD) clinic where Duke nephrologists serve as medical directors and rounding physicians

Exclusion Criteria (providers):

None

Trial design

48 participants in 2 patient groups

Patients who were approached to undergo deprescribing

Description:

If the patient's nephrologist agreed to attempt deprescribing the PIM, either the nephrologist (Provider Only Communication) or a study team member (pharmacist or nurse, Provider/Patient Communication) would engage the patient in discussion about deprescribing.

Treatment:

Behavioral: Deprescribing Intervention

Providers

Description:

Nephrologists and Advanced Practice Providers who see patients at a Duke affiliated DaVita hemodialysis (HD) clinic where Duke nephrologists serve as medical directors and rounding physicians