The impact of medication regimen complexity on patient-related and clinical outcomes in kidney failure: a systematic review

Introduction: Kidney failure is a life-limiting condition that profoundly impacts an individual's quality of life. The significant medication burden on patients required to manage the comorbidities and complications of kidney failure can have implications for patient-reported and clinical outcomes. Methods: This work systematically reviewed methods used to assess medication regimen complexity amongst adults with kidney failure, the associated patient-reported and clinical outcomes, and the effectiveness of interventions to address regimen complexity. A comprehensive search of PubMed, Embase, Web of Science, and Scopus covering all relevant literature up until November 2023 was performed. Results: The findings of this review suggest that patients with kidney failure are prescribed complex medication regimens, which have implications for both clinical and patient-related outcomes. A significant link was found between regimen complexity and poor health outcomes, particularly in the dialysis-dependent patient population. These outcomes included poor quality of life, medication adherence, frailty, hospitalization, and mortality. Interventions to improve medication regimen complexity included de-prescribing tools and pharmacist-led medication management services. Conclusion: Future research should consider well-designed prospective longitudinal studies that develop more comprehensive and standardized definitions of medication regimen complexity. Additionally, multifaceted interventions are needed to address the complex medication regimen to improve outcomes in patients with kidney failure.