> ## Content Index > Fetch the complete content index at: https://nephspace.com/llms.txt > Use this file to discover other available public pages before exploring further. # Deprescribing on hemodialysis is possible, but hard: now we need to work out who does it, when, where and how - URL: https://nephspace.com/deprescribing-hemodialysis-improved-feasibility/ - Published: 2026-10-20T15:14:29.000Z - Updated: 2026-10-20T15:14:29.000Z - Description: The IMPROVED feasibility study offered deprescribing of gabapentin and other potentially inappropriate medications to older adults in 10 dialysis clinics. Seventeen of 41 patients approached agreed to try; symptoms returned in some, without serious events. - Author: Dr Wael Hussein - Tags: Dialysis, #story, #has-audio, #research, #full-story, #in-center-dialysis, Stories **🎧 Listen:** [Weekly · Oct 20](https://nephspace.com/weekly-oct-20/), from 10:38. ### The background Older adults on dialysis are often prescribed potentially inappropriate medications, drugs whose risks frequently outweigh their benefits in older people, such as gabapentinoids and muscle relaxants. In dialysis patients these have been linked to falls, altered mental status, hospitalization and death. The burden keeps growing: a CJASN study this year by Manley and colleagues, covering more than 82,000 patients at a large US dialysis organization, found the average patient was on about 16 medications a day in 2024, up from about 13 in 2003\. Deprescribing, a planned process of reducing or stopping such drugs, is hard in US dialysis clinics, which usually have no embedded pharmacist. ### What the study did Dr. Rasheeda Hall and colleagues at Duke ran a non-randomized feasibility study in 10 dialysis clinics (July 2022 to June 2023) for patients aged 55 or older on hemodialysis for at least 6 months. The target drugs were gabapentinoids, muscle relaxants, Z-drug sleep medicines, alpha blockers and clonidine; opioids and anxiety medicines were deliberately not targeted. The team confirmed active prescriptions, sent nephrologists a tailored recommendation (eventually as a monthly "rounding sheet"), supported a shared decision with the patient, provided a taper plan, and checked in about a month later. The process was refined in Plan-Do-Study-Act cycles. ### What they found - 632 charts were screened and 85 patients were potentially eligible. 44 were ruled out before the patient was asked, most often because the nephrologist didn't agree (20) or the drug had already been stopped (13). That left 41 conversations; 90% involved a gabapentinoid. - 17 of the 41 (41%) agreed to try deprescribing; in 15 of them the drug was gabapentin. - Symptoms such as pain returned in 7 of the 17, with no emergency visits, hospitalizations or deaths related to deprescribing. Only 6 could be reached at 3 months; 4 of 5 gabapentinoid patients were still off the drug. - Of the 7 nephrologists who answered the survey (8 were asked), 5 said the program met their approval or seemed doable, but only 2 said it fit their routine. - In interviews with 10 patients, many viewed the conversation favorably but wanted the reason explained; 4 didn't recall all or part of it. ### Why it matters The authors conclude that workflow, more than acceptability, may be the key barrier. They call for a medication reconciliation step, clearer patient explanations and safe alternatives for pain, and suggest more pharmacist or other prescriber involvement, before a trial of outcomes. They also kept fixing the process to fit how dialysis units work: checking hospital records because clinic medication lists were often wrong, and replacing electronic messages and faxes with a monthly rounding sheet timed to the doctors' rounds. Our take: this study shows how hard deprescribing is. It matters, and we need to figure out how to fit it into our workflow: who does it, when, where and how. In the meantime, for every medication on the list, ask yourself, and your patient, why they're on it. In a Healio Perspective on this study, NephSpace's Dr. Wael Hussein compares deprescribing to decluttering during a move, and wishes that every prescription carried an owner, a reason and clear criteria for stopping. ### Caveats This was a small, single-region feasibility study without a control group. It shows that deprescribing can be done, not that it improves outcomes. Funding and ties: funded by the National Institute on Aging. Dr. Hall reports consulting and other relationships with several companies, including Travere, Otsuka and Chinook; full disclosures are in the paper. Dr. Hussein, who picks NephSpace's papers, wrote the Healio Perspective on this study. --- **The source:** Hall R, Rutledge J, Alvarado H, Wilson J, McDermott C, Morton-Oswald S, Colón-Emeric C. Intervention to Manage and Prevent Overuse of Potentially Inappropriate Medications in Dialysis (IMPROVED): A Feasibility Study. Kidney360\. Published ahead of print 2026\. doi:10.34067/KID.0000001285 [Read the original](https://doi.org/10.34067/KID.0000001285?ref=nephspace.com) **Also discussed:** - Healio, October 14, 2026: Deprescribing for older adults on hemodialysis feasible; but challenges remain (with a Perspective by Dr. Wael Hussein) [Link](https://www.healio.com/news/nephrology/20261014/deprescribing-for-older-adults-on-hemodialysis-feasible-but-challenges-remain?ref=nephspace.com) **🎧 Listen:** [Weekly · Oct 20](https://nephspace.com/weekly-oct-20/), from 10:38. *Physician-led, AI-assisted. Dr. Wael Hussein chooses every item NephSpace covers and reviews and edits every story before it is published. The first draft was written in our own words with AI (Claude, by Anthropic) from the full text of the paper and checked against our reading notes; Dr. Hussein then reviewed and edited it. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our* [*disclaimer*](https://nephspace.com/disclaimer/) *and* [*disclosures*](https://nephspace.com/disclosures/)*. Spotted an error?* [*Tell us*](mailto:hello@nephspace.com?subject=Correction)*.*