Prevalence and Predictors of Polypharmacy Among Patients with Chronic Kidney Disease Undergoing Dialysis or Dialysis-Related Procedures: A Retrospective Observational Study

Abstract

Background: Patients with chronic kidney disease (CKD) undergoing maintenance dialysis typically require multiple concurrent medications to manage renal replacement therapy, its complications, and coexisting comorbidities. Polypharmacy, conventionally defined as concurrent use of five or more medications, increases the risk of drug interactions, adverse drug reactions, and non-adherence, yet locally-grounded data from Indian dialysis populations remain limited.

Objective: To determine the prevalence of polypharmacy and excessive polypharmacy, and to identify the demographic and clinical predictors of medication burden, among CKD patients undergoing maintenance dialysis.

Methods: A retrospective observational study was conducted at a tertiary-care nephrology hospital in Erode, Tamil Nadu, India. Case records of 151 patients with chronic kidney disease (CKD) who underwent maintenance dialysis or dialysis-related procedures were reviewed. Polypharmacy (≥5 drugs) and excessive polypharmacy (≥10 drugs) were assessed. Bivariate associations were tested using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. Variables showing statistically significant bivariate associations were entered into a multivariable binary logistic regression model to identify independent associations.

Results: Polypharmacy was observed in 78.1% of patients (118/151) and excessive polypharmacy in 29.1% (44/151), with a mean of 7.58 ± 3.17 medications per patient. On bivariate analysis, age (p=0.013), serum albumin (p<0.001), and dialysis modality/access category — arteriovenous fistula (AVF)-only versus all other access (p<0.001) — were significantly associated with polypharmacy. On multivariable logistic regression, serum albumin (adjusted OR 0.015, 95% CI 0.001–0.21, p=0.002) and dialysis access category other than AVF-only (adjusted OR 11.61, 95% CI 3.69–36.54, p<0.001) remained independent predictors, while age lost significance after adjustment (p=0.196). Polypharmacy was associated with significantly longer hospital stay (3.52 vs 2.12 days, p<0.001).

Conclusion: Polypharmacy is highly prevalent among dialysis-dependent CKD patients at this centre. Lower serum albumin and dialysis access category other than stand-alone arteriovenous fistula were independently associated with higher odds of polypharmacy, identifying a practical target for pharmacist-led medication review in routine dialysis care.