Effectiveness of a multidisciplinary team-delivered deprescribing intervention for patients with chronic kidney disease: a protocol for a randomised controlled trial

Introduction: Inappropriate polypharmacy is prevalent among patients with chronic kidney disease (CKD), and can be mitigated by deprescribing. We aim to evaluate the clinical and economic impact of a multidisciplinary deprescribing programme in Qatar's healthcare system. Methods: This randomised controlled trial will be conducted at ambulatory dialysis centres, with an internal pilot to assess the feasibility of recruitment, intervention implementation, and safety measures. Patients will be randomised to usual care or an intervention group where a clinical pharmacist, in collaboration with a multidisciplinary healthcare team, will deliver a structured deprescribing intervention, including periodic monitoring over six months. Outcomes will be measured at baseline, three, and six months. The primary outcome is the proportion of patients with at least one potentially inappropriate medication (PIM). Secondary outcomes include pill burden, treatment burden, hospitalisations, emergency department visits, quality of life, and adherence. A cost-benefit analysis will also be performed. A total of 250 patients provides 90% power to detect a 50% reduction in PIM prevalence (α = 0.05). The statistical analysis will be based on the intention-to-treat principle, using mixed-effects models to account for repeated measures. Discussion: Findings will provide novel evidence on deprescribing in CKD, informing future clinical and policy interventions. Trial Registration: ClinicalTrial.gov. NCT06324045. Registered on 15 March 2024.