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💊 Many drugs are cleared by the kidney, yet this scoping review of 69 studies shows that inappropriate prescribing for older adults with reduced kidney function is common in primary care, median prevalence around 25% of patients. Key points: • Harms such as hospitalisation and faster kidney decline are reported, but are still poorly quantified. • Clinicians struggle with multiple eGFR formulas, unclear dosing guidance and limited decision support. • Interventions tested (medication reviews, CDSS, education) show mixed and often modest impact, and are rarely underpinned by clear behavioural theory. 📌 The authors call for guideline clarity on how to assess kidney function in older adults, and for robust, theory informed interventions that can reduce inappropriate prescribing and prevent harm. 🔗 bit.ly/4py71I1