The Kidney Foundation of Canada

Dr. Marisa Battistella 

Dr. Marisa Battistella

University Health Network, Ontario
Co-Investigators: Judith Marin, Cali Osulak, Jo-Anne Wilson

Targeted deprescribing in patients on hemodialysis to reduce polypharmacy

2017-2019:  $99,500  |  Allied Health Research Grants  |  Category: Dialysis, Quality of Life


Marisa graduated from the Faculty of Pharmacy at the University of Toronto in 1998 and completed her pharmacy residency at Sunnybrook and Women’s Health Sciences Centre in 1999. She has worked at the University Health Network since 1999 in various positions, including cardiology and internal medicine. In 2002, Marisa completed her Pharm D thru Idaho State University. She has worked as a clinical pharmacist specialist in the hemodialysis unit at the University Health Network since 2002. Marisa has published several papers and given many presentations on drug therapy in the area of nephrology. Marisa also maintains an active teaching involvement, with the University of Toronto, Leslie Dan Faculty of Pharmacy.

As a Clinician Scientist in Pharmacy at the University Health Network and the Leslie Dan Faculty of, Marisa maintains an active teaching role and focuses much of her time on clinical research in the area of nephrology.
Marisa was also the Chair and education coordinator to the Renal Pharmacists Network (RPN), a national organization for renal pharmacists and currently is the external liaison co-ordinator for the RPN.

Lay Summary

Polypharmacy has been associated with an increased risk of non-adherence to medication regimens, adverse drug events, falls, hospital admissions and mortality. Patients with end stage renal disease on hemodialysis (HD) are exposed to polypharmacy by taking on average 12 medications per day. Deprescribing tools have been developed to reduce polypharmacy and have been successful in the elderly population, but these tools have not been applied directly to the CKD population. Furthermore many medications currently used in HD patients lack the high quality evidence for efficacy and safety seen in the general population and the role of these medications in HD patients is often not known.

The aim of this initiative is to develop tools to guide the re-assessment and deprescribing of specific medications that lack evidence for efficacy and safety in HD patients and to determine the effectiveness of these tools in reducing polypharmacy. Through a review of the literature and discussion with stakeholders within the care team, medication classes fitting the criteria of poor evidence for efficacy and evidence of patient safety concerns in the HD population will be identified. Using the available evidence, medication specific algorithms will be developed and validated to guide re-assessment and potential deprescribing of these medications in HD patients. This initiative will be the development of national consensus driven medication deprescribing algorithms that will be implemented in clinical practice for hemodialysis units across Canada.