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. 2026 Jan 20;16(1):2653.
doi: 10.1038/s41598-025-25632-x.

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

Agathe Mouheb  1   2 , Marie Metzger  3 , Natalia Alencar de Pinho  3 , Christian Jacquelinet  3   4 , Maurice Laville  5 , Ziad A Massy  3   6   7 , Sophie Liabeuf  8   9 , Solène M Laville  1   2 ; CKD-REIN STUDY GROUP
Collaborators, Affiliations

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

Agathe Mouheb et al. Sci Rep. .

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 m2) 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 m2. 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/1.73m2, 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.

Keywords: Adverse outcomes; Chronic kidney disease; Hyperpolypharmacy.

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Conflict of interest statement

Declarations. Competing interests: A.M., S.L., S.M.L., M.M., M.L. have nothing to declare. N.A.P. declare financial support from pharmaceutical companies involved in the CKD-REIN study’s public–private partnership: Fresenius Medical Care, GlaxoSmithKline (GSK), Vifor France, and Boehringer Ingelheim; all the grants were made to Paris Saclay University. Z.A.M. reports having received grants for CKD-REIN and other research projects from Amgen, Baxter, Fresenius Medical Care, GlaxoSmithKline, Merck Sharp & Dohme-Chibret, Sanofi- Genzyme, Lilly, Otsuka, AstraZeneca, Vifor and the French government, as well as fees and grants to charities from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. However, none of the authors has any direct competing financial and/or non-financial interests to disclose in relation to the research presented in this manuscript.

Figures

Fig. 1
Fig. 1
Study flowchart.
Fig. 2
Fig. 2
Changes in the number of daily prescription medications over the 5-year follow-up period.
Fig. 3
Fig. 3
Adjusted hazard ratios for ADR, hospitalization, death before KRT and hyperpolypharmacy (≥ 10 drugs/day). HR, hazard ratio; CI, confidence interval. P-value: NS, non-significant (≥ 0.05); < 0.05*, ≤ 0.01** ; ≤ 0.001.
Fig. 4
Fig. 4
Adjusted hazard ratios for kidney replacement therapy and hyperpolypharmacy (≥ 10 drugs/day), as a function of the eGFR at baseline. HR, hazard ratio; CI, confidence interval; eGFR, estimated glomerular filtration rate. P-value: NS, non-signifiant (≥ 0.05); < 0.05*, ≤ 0.01** ; ≤ 0.001.
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