Evaluation of Prescribing Patterns and Renal Dose Adjustment Practices in Chronic Kidney Disease: A Prospective Observational Study

**Background:** Chronic Kidney Disease (CKD) significantly alters drug pharmacokinetics, increasing the risk of drug accumulation, toxicity, and adverse drug reactions. The coexistence of multiple comorbidities frequently leads to polypharmacy, necessitating careful dose individualization. **Objectives:** To evaluate prescribing patterns, drug utilization, and renal dose adjustment practices in patients with CKD in a tertiary care setting. **Materials and Methods:** A prospective observational study was conducted among 166 CKD patients over six months in a tertiary care hospital. Prescriptions were analyzed using World Health Organization (WHO) prescribing indicators and Anatomical Therapeutic Chemical (ATC) classification. Renal dose appropriateness was assessed using creatinine clearance-based recommendations from standard clinical references. Statistical analysis was performed using the Chi-square test to evaluate associations between CKD stage and dose adjustment requirements. Cockcroft-Gault creatinine clearance was preferentially used for drug dosing decisions because most renal dosing recommendations in standard drug references are based on this equation. **Results:** Of the 166 patients, 65.66% were male, with a mean age of 54.4±16.3 years. The majority were in Stage 5 CKD (75.9%), with hypertension (79.52%) and diabetes mellitus (51.81%) as predominant comorbidities. A total of 1,950 drugs were prescribed, with an average of 12 drugs per prescription, indicating substantial polypharmacy. Generic prescribing accounted for 45.6%, injectable use for 30.8%, and 86.0% of drugs were from the Essential Medicines List. Renal dose adjustment was required in 15.5% of drugs prescribed. No statistically significant association was observed between CKD stage and dose adjustment requirement (*p*=0.55). **Conclusion:** The study demonstrates a high burden of polypharmacy and identifies gaps in optimal prescribing practices, particularly in renal dose individualization. These findings underscore the need for structured prescription audits and proactive clinical pharmacist-led interventions to improve medication safety and therapeutic outcomes in CKD patients. Implementation of renal dosing protocols and clinical decision-support systems may further enhance medication safety and rational prescribing in CKD management.