Reply to: RESPONSE TO “INCORPORATING GERIATRIC ASSESSMENT INTO A NEPHROLOGY CLINIC: PRELIMINARY DATA FROM TWO MODELS OF CARE”

To the Editor

We agree with Dr. Lisi¹ that polypharmacy is a vital part of geriatric assessment in older adults with chronic kidney disease (CKD) and we did not formally address it in our manuscript.² We were unable to report the same details for Renal Silver clinic patients as for Comprehensive Geriatric Assessment for Chronic Kidney Disease (CGA-4-CKD) clinic patients because we did not systematically document medication changes for Renal Silver patients. More than 75% of Renal Silver patients had two or more of the following chronic conditions: diabetes, hypertension, congestive heart failure, cerebrovascular disease and coronary artery disease. For these patients with multimorbidity, medication management requires careful consideration of the potential harms and benefits of following the guideline recommendations for all chronic conditions.³ In this process, some medications would be prioritized based on medications’ side effect profiles, as well as, the patient’s prognosis, symptoms, and goals of care. For patients with declining health, deprescribing medications to meet their needs is also an important strategy.⁴

As we continue to enhance our geriatric program for CKD patients, we look forward to incorporating a formal approach to managing polypharmacy. Specifically, a clinical pharmacist would be a valuable team member who would assist with medication reconciliation, screen for drug-drug interactions and individual drug profiles, optimize medications that treat overlapping chronic conditions, and facilitate strategies to improve medication adherence. Close attention to polypharmacy management would be an important component of maintaining health and quality of life in this population.