Impact of polypharmacy burden, drug-drug interactions, and pharmacist-led deprescribing interventions on chronic kidney disease progression in elderly patients: a multicenter prospective cohort study with embedded randomized controlled trial.

Dr.(Prof.) Hemant  Kumar; Dr. Shashi  Kumar

doi:10.51168/sjhrafrica.v6i12.2630

Authors

Dr. (Prof.) Hemant Kumar MBBS (Gold Medalist), MD, DM(Nephro), FISN(USA), FRCP(Edin) Former Professor & HOD, Nephrology, Patna Medical College, Patna
Dr. Shashi Kumar MBBS, MD, DM (Nephro), FASN, FICP Director & HOD, Nephrosciences, Paras HMRI Hospital, Patna.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2630

Keywords:

polypharmacy, drug-drug interactions, deprescribing, chronic kidney disease, elderly, eGFR, geriatric nephrology

Abstract

Background:

Polypharmacy is highly prevalent among elderly patients with chronic kidney disease (CKD) and is associated with accelerated renal deterioration. However, data on the combined impact of polypharmacy burden, drug-drug interactions (DDIs), and structured deprescribing on eGFR trajectory remain limited.

Objective:

To evaluate the relationship between polypharmacy burden, DDI severity, and eGFR decline in elderly patients with CKD, and to assess the effect of pharmacist-led deprescribing interventions.

Methods:

This prospective cohort study enrolled 1,284 patients aged ≥65 years with CKD stages 3–4 across four tertiary care centers in India (2021–2024). Polypharmacy burden was categorized (1–4, 5–9, 10–14, ≥15 medications). DDIs were screened using Micromedex®, and a validated deprescribing intervention was applied to 644 patients. The primary outcome was eGFR slope over 36 months.

Results:

The mean participant age was 71.4 ± 6.2 years; 58.3% were male. Severe polypharmacy (≥15 drugs) was associated with an annual eGFR decline of −9.7 mL/min/1.73 m² vs −2.1 mL/min/1.73 m² in the low-burden group (p<0.001). Major DDIs were present in 19.3% at baseline. Pharmacist-led deprescribing significantly attenuated eGFR decline (−2.1% vs −8.4% in controls at 12 months; p<0.001) and reduced the prevalence of major DDIs by 38.6%. Multivariable Cox regression identified polypharmacy burden (HR 2.84; 95% CI 1.97–4.09), major DDI (HR 2.31; 95% CI 1.58–3.38), and absence of deprescribing (HR 1.76; 95% CI 1.22–2.54) as independent predictors of rapid renal decline.

Conclusion:

Polypharmacy burden and DDI severity independently accelerate CKD progression in elderly patients. Structured pharmacist-led deprescribing significantly preserves renal function and reduces adverse drug event burden. Routine medication reconciliation and structured pharmacist-led deprescribing programs should be integrated into multidisciplinary CKD care for elderly patients to minimize inappropriate polypharmacy and preserve renal function.

Author Biographies

Dr. (Prof.) Hemant Kumar, MBBS (Gold Medalist), MD, DM(Nephro), FISN(USA), FRCP(Edin) Former Professor & HOD, Nephrology, Patna Medical College, Patna

is a senior nephrologist and former Professor & Head of the Department of Nephrology at Patna Medical College, Patna. His academic interests include chronic kidney disease progression, geriatric nephrology, and renal pharmacotherapy.

Dr. Shashi Kumar, MBBS, MD, DM (Nephro), FASN, FICP Director & HOD, Nephrosciences, Paras HMRI Hospital, Patna.

is Director and Head of the Department of Nephrosciences at Paras HMRI Hospital, Patna. His areas of interest include dialysis medicine, CKD management, and multidisciplinary renal care.

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