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The following is a summary of “Medications for community pharmacists to dose adjust or avoid to enhance prescribing safety in individuals with advanced chronic kidney disease: a scoping review and modified Delphi,” published in the October 2024 issue of Nephrology by Wilson et al. 

Community pharmacists regularly encounter patients with chronic kidney disease (CKD) and are ideally situated to minimize risks from inappropriate medication prescribing. 

Researchers conducted a prospective study to create a medication list for community pharmacists to dose adjust or avoid for patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min. 

They conducted a scoping review to identify high-risk medications that require dose adjustments in patients with advanced CKD. A 3-round modified Delphi process was then carried out, based on the identified medications, to reach consensus on which drugs community pharmacists should adjust or avoid for patients with stage 4 and 5 CKD (non-dialysis). 

The results showed that the scoping review identified 92 articles and 88 medications, with 64 relevant to community pharmacy practice presented to 27 panel experts. The panel included Canadian pharmacists from nephrology (66.7%), geriatrics (18.5%), and primary care (14.8%). All participants completed rounds 1 and 2, and 96% completed round 3. By the end of round 3, the top 40 medications to adjust or avoid were determined, with metformin, gabapentin, pregabalin, non-steroidal anti-inflammatory drugs, nitrofurantoin, ciprofloxacin, and rivaroxaban ranked highest by all round 3 participants. 

Investigators concluded that certain medications could harm patients with advanced CKD, identifying 40 drugs that community pharmacists should adjust or avoid enhancing safety for those with an eGFR below 30 mL/min. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03829-y