Deprescribing for Older Dialysis Patients

摘要 这是为医学博士Rasheeda Hall颁发的Beeson Emerging Leaders in Aging职业发展奖(K76)。 工商管理硕士，理工学院硕士。霍尔博士是一名肾病学家，在杜克大学进行衰老研究，她的长期目标是 是成为老年肾病领域的领导者，并针对老年疾病开发有效的干预措施 在老年透析患者中。与没有肾脏疾病的老年人相比，老年透析患者 可能会出现严重的认知障碍，经历更多的跌倒，并且有更频繁的住院。 众所周知，这些不良后果也与潜在的不适当药物有关，而且年龄更大 透析患者极易受到潜在不适当药物不良反应的影响，因为 肾功能缺失和常见的低血压和微小高血压引起的药物清除改变 中风。考虑到这种敏感性，减少潜在的不适当药物是一个合乎逻辑的目标 提高对这些弱势患者的护理质量。霍尔博士提出的研究的目标是 制定循证策略以减少老年透析患者不适当的处方。这个 研究的目的是：1)确定特定的潜在不适当药物的流行率和程度 与普遍存在的老年透析患者的住院风险有关的因素，2)确定因素 肾内科医生、初级保健提供者和患者可以接受的停药干预措施，以及 3)确定为老年透析患者量身定做的停药干预的可行性。这项工作将 提供证据支持透析室停药的最终临床试验。有效停药 干预有可能减少住院和改善透析中的老年综合征 这与NIA的使命是一致的。作为对这项研究的补充，这项职业发展 该奖项将通过课程作业和指导巩固霍尔博士向研究独立性的过渡：a)填补 指导统计学家团队的知识差距，药物流行病学数据的解释，高级 处理观测数据中的偏差的方法、及时的定性分析、先导研究的实施以及 临床试验设计；b)增强她的领导技能；c)成功竞争R01。杜克大学是 霍尔博士追求这一研究事业发展的理想环境是因为强烈的老龄化 其老龄化中心和附属胡椒中心拥有研究专业知识，以及丰富的资源 可通过杜克大学临床和翻译研究所获得。

ABSTRACT This is a Beeson Emerging Leaders in Aging career development award (K76) for Dr. Rasheeda Hall, MD, MBA, MHS. Dr. Hall is a nephrologist who conducts aging research at Duke University, and her long-term goal is to become a leader in geriatric nephrology and develop effective interventions targeting geriatric conditions in older dialysis patients. Compared to older adults without kidney disease, older dialysis patients are more likely develop severe cognitive impairment, experience more falls, and have more frequent hospitalizations. These adverse outcomes are also known to be associated with potentially inappropriate medications, and older dialysis patients are highly susceptible to adverse effects of potentially inappropriate medications because of altered medication clearance due to absent kidney function and common occurrences of hypotension and mini- strokes. Given this susceptibility, reduction of potentially inappropriate medications is a logical goal for improving quality of care for these vulnerable patients. The objective of Dr. Hall’s proposed research is to develop an evidence-based strategy to reduce inappropriate prescribing in older dialysis patients. The research aims are to: 1) identify the prevalence of specific potentially inappropriate medications and the extent to which there is an association with hospitalization risk in prevalent older dialysis patients, 2) identify elements of a deprescribing intervention that are acceptable to nephrologists, primary care providers, and patients, and 3) determine the feasibility of a deprescribing intervention tailored for older dialysis patients. This work will provide evidence to support a definitive clinical trial of deprescribing in dialysis units. Effective deprescribing interventions have the potential to reduce hospitalizations and ameliorate geriatric syndromes in dialysis patients which is consistent with NIA’s mission. Complementary to this research, this career development award will solidify Dr. Hall’s transition to research independence through coursework and mentoring to: a) fill knowledge gaps in directing a team of statisticians, interpretation of pharmacoepidemiologic data, advanced methods in handling bias in observational data, timely qualitative analyses, execution of a pilot study, and clinical trial design; b) enhance her leadership skills; and c) successfully compete for a R01. Duke University is the ideal environment for Dr. Hall to pursue this research career development because of the strong aging research expertise housed in its Center for Aging and affiliated Pepper Center, as well as, rich resources available through Duke’s Clinical and Translational Institute.