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<p>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 &lt; 60&#xa0;mL/min/1.73&#xa0;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&#xa0;years and mean eGFR was 34&#xa0;mL/min/1.73&#xa0;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&#xa0;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 &lt; 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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月20日

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

摘要

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.