Reducing Polypharmacy-Related Adverse Outcomes in Older Adults with Chronic Kidney Disease: A Retrospective Cohort Study of a Digitally Mediated Pharmacist Intervention

<b>Background/Objectives</b>: Older adults with chronic kidney disease (CKD) are particularly vulnerable to polypharmacy-related adverse outcomes due to altered pharmacokinetics, multimorbidity, and increased susceptibility to medication-related harm. Polypharmacy in CKD is associated with falls, hospitalizations, and functional decline. Clinical pharmacist-led medication reviews may mitigate these risks; however, access barriers limit their implementation in routine care. To evaluate the clinical impact of a digitally mediated pharmacist consultation service on medication burden, fall risk, healthcare utilization, and resource use among older adults with CKD and polypharmacy. <b>Methods</b>: We conducted a retrospective cohort study using anonymized electronic medical records from a large integrated healthcare organization. Adults aged ≥ 65 years with CKD and polypharmacy (≥8 chronic medications) were included. Patients receiving a structured digital medication review by a clinical pharmacist, delivered via the primary care physician, were compared with a comparable control group of eligible patients who did not receive the intervention during the study period. Outcomes included changes in medication use, fall risk, renal function, and healthcare utilization. <b>Results</b>: Among 6124 eligible patients (1226 intervention; 4898 control), pharmacist consultation was associated with a modest but clinically meaningful reduction in medication burden and a higher likelihood of fall-risk reduction compared with controls. Decreases in outpatient healthcare utilization were also observed following the intervention. Renal function decline was similar between groups. <b>Conclusions</b>: A digitally mediated, physician-integrated pharmacist consultation may reduce polypharmacy-related risks and adverse outcomes in older adults with CKD. This model offers a scalable approach to improving medication safety in a high-risk CKD population while minimizing reliance on patient digital engagement.