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New tools help hemodialysis patients understand which medications can be stopped safely

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Many kidney patients express concern about stopping medications, also known as deprescribing, when they don’t understand the reasons. To help provide clarity, a nation-wide research team created a suite of educational tools to help patients stop taking certain medications, which they validated in a study published earlier this year in the Canadian Journal of Kidney Disease and Health.

Judith Marin, a clinical pharmacy specialist at St. Paul’s Hospital in Vancouver, was involved in the study. She notes that hemodialysis patients, as well as people living with kidney disease in general, tend to take a lot of medications.

“But there is actually minimal data to support these patients to be on all of these medications, and sometimes to simplify their regimens is the best thing,” she explains.

For example, patients may be prescribed medication for heartburn, which is meant to be taken over short periods of time. If taken for extended periods of time, it can cause harmful side effects like diarrhea or decreased bone mass.

But clinicians sometimes don’t re-assess patients to see which medications can be safely deprescribed, and some patients may be hesitant to stop a medication that was prescribed for a valid reason at an earlier time.

As part of a national team funded by the patient-oriented kidney research network, Can-SOLVE CKD, Marin and her colleagues previously created a clinical tool that doctors can use to deprescribe medications for their hemodialysis patients. In their most recent study, the research team created ten different educational tools, for example an infographic handout and a video, to help educate patients on which medications can be stopped safely and why.

Importantly, the educational materials were co-created with the help of patient partners, which ensures the materials are clear and easy for patients to understand. Then the research team interviewed a total of 105 patients at sites in Vancouver, Toronto and Winnipeg to validate how useful patients found the educational materials.

The results show that the validity of the tools ranged from 72% to 100%, with the majority scoring above 90%.

A particularly unique aspect of this study is that patient partners helped lead the interviews. Dennis McCann is a patient partner based in Vancouver who was involved in this effort. He cites his own personal experience with taking a lot of medications at once, which has shaped and reinforced his views on the importance of deprescribing.

“I found the experience of leading patient interviews to be enlightening and challenging at the same time,” says McCann, noting he had the chance to go over the educational materials with patients in detail, and help them understand the benefits of deprescribing. “I think that was probably the most fulfilling aspect, as a patient partner, for me to participate in that process.”

Now that the research team has validated these tools, they are looking for ways to implement them more broadly across Canada. A pilot study in a hemodialysis unit in Toronto is currently underway before the project is expanded into dialysis units in other parts of the country. 

“The aim is to decrease the pill burden for as many hemodialysis patients across the country as possible, improving the quality of life of kidney patients and decreasing health-care costs,” says Marin.



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