Evidence mapPaperPMID 39472832Full record

ArticleBMC nephrology2024

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.

Jo-Anne Wilson, Natalie Ratajczak, Katie Halliday, Marisa Battistella, Heather Naylor, Maneka Sheffield, Judith G Marin, Jennifer Pitman, Natalie Kennie-Kaulbach, Shanna Trenaman and 1 more

Registry-linked trialAbstract readScoping Review
In one paragraph

Article in BMC nephrology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06820372 (Improving Medication Safety and Prescribing for Individuals Chronic Kidney Disease), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06820372 not yet recruitingnot on this mapstarted 2025, after this paper: background citation

Improving Medication Safety and Prescribing for Individuals Chronic Kidney Disease (CKD) Through the Implementation and Evaluation of an Electronic Drug Dosing and Decision Support Kidney (eDoseCKD) Tool for Nova Scotia Community Pharmacy.

TypeobservationalSponsorNova Scotia Health AuthorityRan2025 to 2026Enrolled125ConditionsChronic Kidney Disease Stage 4, Chronic Kidney Disease Stage 5ArmsElectronic Drug Dosing and Decision Support Kidney (eDoseCKD) Tool
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Trial
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jo-Anne WilsonCollege of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada. Jo-Anne.Wilson@dal.ca.ORCID 0000-0003-3423-5740
Natalie Ratajczak *College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
Katie Halliday *College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
Marisa BattistellaLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.ORCID 0000-0001-9456-4365
Heather NaylorRegional Research and Education, Horizon Health Network, St. John, New Brunswick, Canada.ORCID 0009-0008-3801-8907
Maneka SheffieldNova Scotia Health Renal Program, Halifax, NS, Canada.
Judith G MarinSt. Paul's Hospital, Kidney Care Clinic, Vancouver, BC, Canada.ORCID 0000-0001-9317-8809
Jennifer PitmanPharmacy Department, Nova Scotia Health, Halifax, NS, Canada.ORCID 0000-0002-7250-1600
Natalie Kennie-KaulbachCollege of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.ORCID 0000-0002-4792-9365
Shanna TrenamanCollege of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.ORCID 0000-0002-7982-4437
Louise GillisW.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada.ORCID 0000-0001-8250-5886

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCommunity pharmacists commonly see individuals with chronic kidney disease (CKD) and are in an ideal position to mitigate harm from inappropriate prescribing. We sought to develop a relevant medication list for community pharmacists to dose adjust or avoid in individuals with an estimated glomerular filtration rate (eGFR) below 30 mL/min informed through a scoping review and modified Delphi panel of nephrology, geriatric and primary care pharmacists.

methodsA scoping review was undertaken to identify higher risk medications common to community pharmacy practice, which require a dose adaptation in individuals with advanced CKD. A 3-round modified Delphi was conducted, informed by the medications identified in our scoping review, to establish consensus on which medications community pharmacists should adjust or avoid in individuals with stage 4 and 5 CKD (non-dialysis).

resultsNinety-two articles and 88 medications were identified from our scoping review. Of which, 64 were deemed relevant to community pharmacy practice and presented for consideration to 27 panel experts. The panel consisted of Canadian pharmacists practicing in nephrology (66.7%), geriatrics (18.5%) and primary care (14.8%). All participants completed rounds 1 and 2 and 96% completed round 3. At the end of round 3, the top 40 medications to adjust or avoid were identified. All round 3 participants selected metformin, gabapentin, pregabalin, non-steroidal anti-inflammatory drugs, nitrofurantoin, ciprofloxacin and rivaroxaban as the top ranked medications.

conclusionMedications eliminated by the kidneys may accumulate and cause harm in individuals with advanced chronic kidney disease. This study provides an expert consensus of the top 40 medications that community pharmacists should collaboratively adjust or avoid to enhance medication safety and prescribing for individuals with an eGFR below 30 mL/min.

Indexed as

Delphi TechniqueRenal Insufficiency, ChronicCommunity Pharmacy ServicesGlomerular Filtration RateHumansInappropriate PrescribingPharmacistsChronic Kidney DiseaseCommunity Pharmacy PracticeEducationMedication Safety

Identifiers

PMID39472832
PMCPMC11523796

What Socratic holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.