Hyperpolypharmacy in patients with chronic kidney disease and its impact on clinical outcomes

Hyperpolypharmacy (≥ 10 daily medications) is frequent in patients with chronic kidney disease (CKD), but its impact remains poorly characterized. This study, based on 3,011 non-dialyzed, non-transplant CKD outpatients from the CKD-REIN cohort (eGFR < 60 mL/min/1.73 m<sup>2</sup>) aimed to describe drug burden and assess associations between hyperpolypharmacy and adverse outcomes. Drug prescription, kidney function, adverse drug reactions (ADRs), hospitalizations, kidney replacement therapy and deaths before KRT were prospectively recorded over five years. Median age was 69 years and mean eGFR was 34 mL/min/1.73 m<sup>2</sup>. At baseline, 80% of the cohort had polypharmacy (≥ 5 daily medications), and 33% had hyperpolypharmacy. These rates remained stable over time. Diabetes, dyslipidemia, and a history of cardiovascular and respiratory diseases were the main contributors to hyperpolypharmacy status. Hyperpolypharmacy was associated with greater likelihoods of an ADR (hazard ratio (HR) [95% confidence interval (CI)] 1.21 [1.04-1.40]), hospitalization (HR [95%CI] 1.34 [1.18-1.51]) and death before KRT (HR [95%CI] 1.46 [1.17-1.82]). Among patients with eGFR ≥ 30 mL/min/1.73m<sup>2</sup>, hyperpolypharmacy also raised the risk of KRT initiation (HR [95%CI] 1.46 [1.00-2.13]), but not in those with eGFR < 30 (HR [95%CI] 0.94 [0.78-1.14]). These results identify hyperpolypharmacy as a significant concern in CKD and underscore the importance of regular medication reviews to reduce adverse outcomes.

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Journal
Scientific Reports
Published
2026-01-20
DOI
https://doi.org/10.1038/s41598-025-25632-x
Primary Topic
Diabetes Treatment and Management
Type
article
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0.00

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article

Hyperpolypharmacy in patients with chronic kidney disease and its impact on clinical outcomes

Solène M. Laville, Marie Metzger, Pascal Morel, Maurice Laville et al.
Scientific Reports
Diabetes Treatment and Management
article

Hyperpolypharmacy in patients with chronic kidney disease and its impact on clinical outcomes

Solène M. Laville, Marie Metzger, Pascal Morel, Maurice Laville, Agathe Mouheb, Christophe Pascal, Denis Fouque, Ziad A Massy, Christian Combe, Bénédicte Stengel, Luc Frimat, N. Maisonneuve, A. Keller, C. Combe, D. Fouque, C. Noël, H. Sekhri, S. Burtey, C. Delclaux, X. Belenfant, F. Kuentz, M. Hourmant, M. Smati, G. Choukroun, Natalia Alencar de Pinho, V. Panescu, D. Clément, P. Lang, Investigators, A. Testa, Christian Jacquelinet, N. Kamar, Aghilès Hamroun, C. Vela, T. Lobbedez, B. Deroure, T. Hannedouche, F. Glowacki, M. Bellou, Dorothée Cannet, M. Essig, R. Azar, C. Chazot, E. Thervet, Joost Schantsra, J. P. Bourdenx, A. Klein, Z. Massy, B. Moulin, G. Lebrun, L. Juillard, M. Delahousse, E. Magnant, M. Laville, I. Landru, P. Urena, P. Zaoui, M. Hoffmann, B. Vendrely, Sophie Liabeuf, D. Besnier, Céline Lange, B. Hacq, M. Jamali, Oriane Lambert, G. Lambrey, Roberto Pecoits-Filho, A. Lacraz
article en

Abstract

Hyperpolypharmacy (≥ 10 daily medications) is frequent in patients with chronic kidney disease (CKD), but its impact remains poorly characterized. This study, based on 3,011 non-dialyzed, non-transplant CKD outpatients from the CKD-REIN cohort (eGFR < 60 mL/min/1.73 m<sup>2</sup>) aimed to describe drug burden and assess associations between hyperpolypharmacy and adverse outcomes. Drug prescription, kidney function, adverse drug reactions (ADRs), hospitalizations, kidney replacement therapy and deaths before KRT were prospectively recorded over five years. Median age was 69 years and mean eGFR was 34 mL/min/1.73 m<sup>2</sup>. At baseline, 80% of the cohort had polypharmacy (≥ 5 daily medications), and 33% had hyperpolypharmacy. These rates remained stable over time. Diabetes, dyslipidemia, and a history of cardiovascular and respiratory diseases were the main contributors to hyperpolypharmacy status. Hyperpolypharmacy was associated with greater likelihoods of an ADR (hazard ratio (HR) [95% confidence interval (CI)] 1.21 [1.04-1.40]), hospitalization (HR [95%CI] 1.34 [1.18-1.51]) and death before KRT (HR [95%CI] 1.46 [1.17-1.82]). Among patients with eGFR ≥ 30 mL/min/1.73m<sup>2</sup>, hyperpolypharmacy also raised the risk of KRT initiation (HR [95%CI] 1.46 [1.00-2.13]), but not in those with eGFR < 30 (HR [95%CI] 0.94 [0.78-1.14]). These results identify hyperpolypharmacy as a significant concern in CKD and underscore the importance of regular medication reviews to reduce adverse outcomes.

Scientific ReportsVol. 16(1)
Université Claude Bernard Lyon 1 (FR), Université Paris-Sud (FR), Inserm (FR), Pontifícia Universidade Católica do Paraná (BR), Université Fédérale de Toulouse Midi-Pyrénées (FR), Université Paris-Saclay (FR), Centre Hospitalier Universitaire de Grenoble (FR), Centre Hospitalier Universitaire de Bordeaux (FR), Centre Hospitalier Universitaire de Lille (FR), Centre Hospitalier Universitaire de Nantes (FR), Centre Hospitalier Universitaire de Toulouse (FR), Centre Hospitalier de Perpignan (FR), Hopitaux Civils de Colmar (FR), Centre Hospitalier Universitaire Amiens-Picardie (FR), Assistance Publique – Hôpitaux de Paris (FR), Centre Régional d’Innovation et de Transferts Technologiques des Industries du Bois (FR), Centre Paul Albert-Février (FR), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hospices Civils de Lyon (FR), Centre de recherche en Epidémiologie et Santé des Populations (FR), PHV Dialysezentrum (DE), Bordeaux Population Health (FR), Centre Hospitalier Intercommunal Aix-Pertuis (FR), NephroCare Tassin-Charcot (FR), Centre Hospitalier de Beauvais (FR), Hôpital Lyon Sud (FR), Centre Hospitalier Universitaire de Caen Normandie (FR), Centre Hospitalier Universitaire de Limoges (FR), Hôpital Edouard Herriot (FR), Laboratoire de recherche en cardiovasculaire, métabolisme, diabétologie et nutrition (FR), Centre Hospitalier de la Côte Basque (FR), Metabolism and Renal Physiology (FR), Établissement Français du Sang (FR), Agence de la Biomédecine (FR), Hôpital Ambroise-Paré (FR), Arbor Research Collaborative for Health (US), Clinique Pasteur (FR), Réseau pour la Transition Énergétique (FR), Centre Hospitalier Départemental Vendée (FR), Institut des Maladies Métaboliques et Cardiovasculaires (FR), Centre Hospitalier de Valenciennes (FR), Laboratoire Saint Martin (FR), Hôpital Foch (FR), Hôpital Intercommunal de Créteil (FR), Centre Hospitalier Saint-Nazaire (FR), Association pour l'Utilisation du Rein Artificiel (FR), Clinique du Grand Large (FR), Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes – Région Est (FR), Université de Picardie Jules Verne (FR), Université Jean Moulin Lyon III (FR), Université de Lorraine (FR)
Amgen, Eli Lilly and Company, AstraZeneca, GlaxoSmithKline, Sanofi, MSD France, Fresenius Medical Care North America, Agence Nationale de la Recherche, Institut National de la Santé et de la Recherche Médicale, Novo Nordisk, Otsuka Pharmaceutical, Agence Nationale de Sécurité du Médicament et des Produits de Santé, Boehringer Ingelheim France, Inserm Transfert
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