The burden of polypharmacy among hemodialysis patients in Saudi Arabia: a multicenter cross-sectional study of prevalence and associated factors

Abstract Background Polypharmacy is prevalent in patients undergoing maintenance hemodialysis due to the burden of comorbidities and dialysis-related complications. Despite the growing population of patients undergoing hemodialysis in Saudi Arabia, data on the prevalence and its associated factors remain limited. Excessive medication use has been associated in previous studies with a higher risk of adverse drug reactions, complications, and mortality. Objectives To assess the prevalence of polypharmacy and identify demographic and clinical factors associated with polypharmacy among patients undergoing maintenance hemodialysis in Saudi Arabia. Methods This multicenter cross-sectional study was conducted among adults on maintenance hemodialysis at four dialysis centers in Saudi Arabia between January and October 2025. Polypharmacy was defined as the concurrent use of ≥ 5 medications, excessive polypharmacy as ≥ 10 medications, and hyperpolypharmacy as ≥ 15 medications. Polypharmacy prevalence was estimated with a 95% confidence interval using the Wilson score method. Multivariable logistic regression was used to identify demographic and clinical factors associated with polypharmacy. Dialysis-unit-administered medications were excluded. Results A total of 527 patients were included in the study. Polypharmacy was identified in 369 of 527 patients (70%; 95% CI, 66%–73.8%). Of these 369 patients, 128 (24.3% of the cohort) had excessive polypharmacy, and 10 of those 128 (1.9% of the cohort) had hyperpolypharmacy. After logistic regression analysis, older age, a greater number of comorbidities, and a higher number of prescriber counts were associated with higher odds of polypharmacy (OR 1.02, 95% CI 1.00–1.04; p = 0.01), (OR 1.40, 95% CI 1.12–1.73; p < 0.01), and (OR 3.86, 95% CI 2.95–5.06; p < 0.001), respectively. Conclusion In this multicenter cross-sectional study of hemodialysis patients in Saudi Arabia, polypharmacy was common, affecting 70% of patients, and was associated with older age, a greater comorbidity burden, and a higher number of prescribers. These findings highlight key patient- and system-level targets for interventions such as structured medication review and improved prescriber coordination to enhance medication safety in this population.