Multidisciplinary Team Delivered Deprescribing Intervention for Patients Receiving Maintenance Hemodialysis: A Pilot Randomized Controlled Trial

PURPOSE: Inappropriate polypharmacy is highly prevalent among patients with chronic kidney disease (CKD) and could be reduced through targeted deprescribing interventions. We aimed to evaluate the feasibility and preliminary effectiveness of a multidisciplinary team-delivered deprescribing intervention for CKD patients undergoing hemodialysis (HD). METHODS: A parallel-group pilot randomized controlled trial (RCT) was conducted among adult HD patients. Participants were randomized into either intervention or control groups. The intervention group received a structured deprescribing program using an evidence-based protocol and algorithms. Outcome measures were assessed at baseline, three, and six months. The primary outcomes were feasibility and safety, while secondary outcomes included the number of potentially inappropriate medications (PIMs), pill burden, health service utilization, medication adherence, treatment burden, and quality of life. FINDINGS: Of 75 eligible patients, 54 (72%) were recruited, and three (5.6%) withdrew. All intervention components were delivered with no serious adverse events. At six months, the control group had four times more PIMs than the intervention (RR = 4.03, 95% CI 2.78-5.84; P < 0.001). There were no significant differences over time between the groups in pill burden, treatment burden, adherence, and quality of life. Overall, 85.1% of the proposed deprescribing plans were successfully implemented, with six discontinued due to recurrent symptoms or patient preference. The most commonly deprescribed medications were proton pump inhibitors and antihypertensives. IMPLICATIONS: The multidisciplinary deprescribing intervention was feasible, safe, and demonstrated preliminary effectiveness in reducing PIMs among HD patients. These findings support progression to a definitive RCT to confirm the effectiveness. TRIAL REGISTRATION: ClinicalTrial.gov. NCT06324045. Registered on 15 March 2024.