Structured Medication Reviews (SMRs) were introduced into the National Health Service (NHS) Primary Care to support the delivery of the NHS Long-Term Plan for medicines optimisation. SMRs improve the quality of care, reduce harm, and offer value for money. However, evidence to support SMRs for patients with chronic kidney disease (CKD) stage G4-5D with elevated risk of cardiovascular disease and premature mortality is unknown. This scoping review aimed to assess the extent and nature of SMR research in the population of patients with CKD stage G4-5D. Electronic databases were searched on 20 October 2023. Studies were eligible if they described an SMR in adults with CKD stage G4-5D, regardless of the study design. Data detailing the global patterns, population and intervention descriptions, professionals performing SMR, and reported areas for future research were extracted. The extracted outcome data were categorised as clinically important, patient-important, medication-related, and experience-related. A narrative synthesis was completed. Seventeen studies (81%) were conducted in nephrology outpatient setting, three (14%) during acute hospital admissions, and one (5%) within the community pharmacy. Eighteen studies (86%) were quantitative, to include five randomised controlled trials. Ten (48%) studies were undertaken in the United States of America and Canada, and two in Europe (France and Norway). No such studies have been conducted in the United Kingdom. Our review revealed that there is a lack of evidence for SMR as a strategy to reduce polypharmacy and harms from medication for adults with CKD stage G4-5D. Therefore, further research is required in this area.