J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 2, February 2026, pages 99-106

Polypharmacy and Dose Adjustment in Chronic Kidney Disease: A Cross-Sectional Study

↓ **Table 1.** Patient Characteristics at the Time of Study Inclusion
Variable	Result
CKD: chronic kidney disease; KDIGO: Kidney Disease: Improving Global Outcomes; ND: non-dialysis; D: dialysis; eGFR: estimated glomerular filtration rate.
Gender (females/males, %)	47.2/52.8
Age (years)	77 ± 10.9
In-hospital therapy (days)	13.2 ± 11.7
CKD etiology n (%)
Diabetic/hypertensive nephropathy	45 (42.5)
Hypertensive nephropathy	34 (32.1)
Diabetic nephropathy	15 (14.2)
Glomerulonephritis	1 (0.9)
Other	1 (0.9)
Unknown	10 (9.4)
CKD stage (KDIGO 2024) n (%)
2	10 (9.6)
3	56 (53.8)
4	16 (15.4)
5 (ND/D)	22 (21.2)
Reason for hospitalization n (%)
Heart failure	43 (40.6)
Pneumonia	21 (19.8)
Non-respiratory infections including sepsis	10 (9.4)
Metabolic disorder	6 (5.7)
Acute kidney injury (with pre-existing CKD)	5 (4.7)
Vascular disorder	5 (4.7)
Chronic kidney disease	4 (3.8)
Malignant disorder	3 (2.8)
Liver cirrhosis/liver failure	2 (1.9)
Trauma	2 (1.9)
Other	5 (4.7)
Laboratory findings on admission
eGFR (mL/min)	31.6 ± 17.6
Serum sodium (mmol/L)	136.4 ± 5.9
Serum potassium (mmol/L)	4.4 ± 0.8
Serum calcium (mmol/L)	1.8 ± 0.4
Serum phosphate (mmol/L)	1.4 ± 0.6
Hemoglobin (g/L)	111.9 ± 22.2
Morbidities n (%)
Arterial hypertension	80 (75.5)
Coronary artery disease	46 (43.3)
Chronic heart failure	34 (32.1)
Obesity	29 (27.3)
Diabetes mellitus	58 (54.7)
Chronic obstructive pulmonary disease	23 (19.4)
History of neoplasia	18 (17)
Smoking	12 (11.3)

↓ Table 1. Patient Characteristics at the Time of Study Inclusion

Variable

Result

CKD: chronic kidney disease; KDIGO: Kidney Disease: Improving Global Outcomes; ND: non-dialysis; D: dialysis; eGFR: estimated glomerular filtration rate.

Gender (females/males, %)

47.2/52.8

Age (years)

77 ± 10.9

In-hospital therapy (days)

13.2 ± 11.7

CKD etiology n (%)

Diabetic/hypertensive nephropathy

45 (42.5)

Hypertensive nephropathy

34 (32.1)

Diabetic nephropathy

15 (14.2)

Glomerulonephritis

1 (0.9)

Other

1 (0.9)

Unknown

10 (9.4)

CKD stage (KDIGO 2024) n (%)

10 (9.6)

56 (53.8)

16 (15.4)

5 (ND/D)

22 (21.2)

Reason for hospitalization n (%)

Heart failure

43 (40.6)

Pneumonia

21 (19.8)

Non-respiratory infections including sepsis

10 (9.4)

Metabolic disorder

6 (5.7)

Acute kidney injury (with pre-existing CKD)

5 (4.7)

Vascular disorder

5 (4.7)

Chronic kidney disease

4 (3.8)

Malignant disorder

3 (2.8)

Liver cirrhosis/liver failure

2 (1.9)

Trauma

2 (1.9)

Other

5 (4.7)

Laboratory findings on admission

eGFR (mL/min)

31.6 ± 17.6

Serum sodium (mmol/L)

136.4 ± 5.9

Serum potassium (mmol/L)

4.4 ± 0.8

Serum calcium (mmol/L)

1.8 ± 0.4

Serum phosphate (mmol/L)

1.4 ± 0.6

Hemoglobin (g/L)

111.9 ± 22.2

Morbidities n (%)

Arterial hypertension

80 (75.5)

Coronary artery disease

46 (43.3)

Chronic heart failure

34 (32.1)

Obesity

29 (27.3)

Diabetes mellitus

58 (54.7)

Chronic obstructive pulmonary disease

23 (19.4)

History of neoplasia

18 (17)

Smoking

12 (11.3)

↓ **Table 2.** Substance Groups Including All Individual Substances
Group	Substances	N (%) of all substances applied
Hemodynamic/diuretic	Adaption required: chlorthalidone, enalapril, empagliflozin, eplerenone, hydrochlorothiazide, indapamide, lercanidipine, lisinopril, moxonidine, naftidrofuryl oxalate, nebivolol, olmesartan, propranolol, ramipril, sacubitril, spironolactone, telmisartan, torsemide	39 (18.7%)
	Adaption not required: amlodipine, bisoprolol, candesartan, carvedilol, clonidine, dihydropyridine derivative, doxazosin, felodipine, furosemide, glyceryl trinitrate, isosorbide mononitrate, losartan, metoprolol, minoxidil, molsidomine, nitrendipine, noradrenaline, urapidil, valsartan, verapamil, xipamide
Antiarrhythmic	Adaption not required: amiodarone	1 (0.47%)
Antithrombotic/anticoagulatory	Adaption required: acetylsalicylic acid, apixaban, edoxaban, enoxaparin, heparin, phenprocoumon, rivaroxaban	11 (5.26%)
	Adaption not required: clopidogrel, digitoxin, prasugrel, ticagrelor
Pulmonary	Adaption required: fenoterol, salbutamol	16 (7.65%)
	Adaption not required: acetylcysteine, aclidinium, ambroxol, beclomethasone, budesonide, formoterol, glycopyrronium bromide, indacaterol, ipratropium bromide, montelukast, olodaterol, salmeterol, theophylline, tiotropium
Antimicrobial	Adaption required: acyclovir, amphotericin B, cefuroxime, ciprofloxacin, clarithromycin, co-trimoxazole, erythromycin, flucloxacillin, gentamicin, levofloxacin, meropenem, piperacillin, valganciclovir, vancomycin	23 (11%)
	Adaption not required: ampicillin + sulbactam, azithromycin, cefpodoxime, ceftazidime, ceftriaxone, linezolid, metronidazole, nystatin, rifaximin
Immunomodulatory/antiallergic	Adaption required: mesalamine	12 (5.74%)
	Adaption not required: adalimumab, dexamethasone, everolimus, fexofenadine, fluticasone, hydrocortisone, methylprednisolone, mycophenolic acid, prednisolone, rituximab, tofacitinib
Antidiabetics	Adaption required: glimepiride, metformin, semaglutide, sitagliptin, vildagliptin	6 (2.87%)
	Adaption not required: insulin
Metabolic/hormonal/vitamins	Adaption required: alendronate, allopurinol, cholecalciferol, epoetin alfa, magnesium, Nutriflex^® Peri, pravastatin, rosuvastatin, sevelamer, simvastatin, sodium bicarbonate, sodium polystyrene sulfonate	42 (20.09%)
	Adaption not required: alfacalcidol, atorvastatin, bicalutamide, calcium, calcium carbonate, calcitriol, cinacalcet, darbepoetin alpha, denosumab, Dreisavit^® (water soluble vitamins), dutasteride, exemestane, ezetimibe, febuxostat, Ferrlecit^®, Ferro Sanol^®, finasteride, folic acid, Fosrenol^®, glucose, hyaluronic acid, levothyroxine, potassium, Renavit (water soluble vitamins), Tardyferon, thiamazol, vitamin B1, vitamin B6, vitamin B12, Vitarenal^® (water soluble vitamins)
Psychotropic	Adaption required: amitriptyline, citalopram, diazepam, midazolam, mirtazapine, opipramol, piracetam, risperidone	17 (8.13%)
	Adaption not required: benperidol, doxepin, lorazepam, melatonin, melperone, paroxetine, pipamperon, trimipramine, zopiclone
Analgesic	Adaption required: ketoprofen, morphine, oxycodone	11 (5.26%)
	Adaption not required: buprenorphine, fentanyl, metamizole, naloxegol, paracetamol, tilidine, tramadol, xylometazoline
Gastrointestinal	Adaption required: Dropizol^®, metoclopramide, omeprazole, pantoprazole	9 (4.3%)
	Adaption not required: espumisan, granisetron, lactulose, macrogol, saccharomyces cerevisiae
Neuromuscular	Adaption required: gabapentin, galantamine, lamotrigine, levetiracetam, levodopa, Madopar^®, pramipexole, pregabalin, propiverine, venlafaxine	15 (7.17%)
	Adaption not required: darifenacin, propofol, quetiapine, remifentanil, valproate
Other	Adaption not required: Helixor^®, latanoprost, letrozole, olopatadine, osimertinib, tamsulosin, timolol	7 (3.34%)

↓ Table 2. Substance Groups Including All Individual Substances

Group

Substances

N (%) of all substances applied

Hemodynamic/diuretic

Adaption required: chlorthalidone, enalapril, empagliflozin, eplerenone, hydrochlorothiazide, indapamide, lercanidipine, lisinopril, moxonidine, naftidrofuryl oxalate, nebivolol, olmesartan, propranolol, ramipril, sacubitril, spironolactone, telmisartan, torsemide

39 (18.7%)

Adaption not required: amlodipine, bisoprolol, candesartan, carvedilol, clonidine, dihydropyridine derivative, doxazosin, felodipine, furosemide, glyceryl trinitrate, isosorbide mononitrate, losartan, metoprolol, minoxidil, molsidomine, nitrendipine, noradrenaline, urapidil, valsartan, verapamil, xipamide

Antiarrhythmic

Adaption not required: amiodarone

1 (0.47%)

Antithrombotic/anticoagulatory

Adaption required: acetylsalicylic acid, apixaban, edoxaban, enoxaparin, heparin, phenprocoumon, rivaroxaban

11 (5.26%)

Adaption not required: clopidogrel, digitoxin, prasugrel, ticagrelor

Pulmonary

Adaption required: fenoterol, salbutamol

16 (7.65%)

Adaption not required: acetylcysteine, aclidinium, ambroxol, beclomethasone, budesonide, formoterol, glycopyrronium bromide, indacaterol, ipratropium bromide, montelukast, olodaterol, salmeterol, theophylline, tiotropium

Antimicrobial

Adaption required: acyclovir, amphotericin B, cefuroxime, ciprofloxacin, clarithromycin, co-trimoxazole, erythromycin, flucloxacillin, gentamicin, levofloxacin, meropenem, piperacillin, valganciclovir, vancomycin

23 (11%)

Adaption not required: ampicillin + sulbactam, azithromycin, cefpodoxime, ceftazidime, ceftriaxone, linezolid, metronidazole, nystatin, rifaximin

Immunomodulatory/antiallergic

Adaption required: mesalamine

12 (5.74%)

Adaption not required: adalimumab, dexamethasone, everolimus, fexofenadine, fluticasone, hydrocortisone, methylprednisolone, mycophenolic acid, prednisolone, rituximab, tofacitinib

Antidiabetics

Adaption required: glimepiride, metformin, semaglutide, sitagliptin, vildagliptin

6 (2.87%)

Adaption not required: insulin

Metabolic/hormonal/vitamins

Adaption required: alendronate, allopurinol, cholecalciferol, epoetin alfa, magnesium, Nutriflex^® Peri, pravastatin, rosuvastatin, sevelamer, simvastatin, sodium bicarbonate, sodium polystyrene sulfonate

42 (20.09%)

Adaption not required: alfacalcidol, atorvastatin, bicalutamide, calcium, calcium carbonate, calcitriol, cinacalcet, darbepoetin alpha, denosumab, Dreisavit^® (water soluble vitamins), dutasteride, exemestane, ezetimibe, febuxostat, Ferrlecit^®, Ferro Sanol^®, finasteride, folic acid, Fosrenol^®, glucose, hyaluronic acid, levothyroxine, potassium, Renavit (water soluble vitamins), Tardyferon, thiamazol, vitamin B1, vitamin B6, vitamin B12, Vitarenal^® (water soluble vitamins)

Psychotropic

Adaption required: amitriptyline, citalopram, diazepam, midazolam, mirtazapine, opipramol, piracetam, risperidone

17 (8.13%)

Adaption not required: benperidol, doxepin, lorazepam, melatonin, melperone, paroxetine, pipamperon, trimipramine, zopiclone

Analgesic

Adaption required: ketoprofen, morphine, oxycodone

11 (5.26%)

Adaption not required: buprenorphine, fentanyl, metamizole, naloxegol, paracetamol, tilidine, tramadol, xylometazoline

Gastrointestinal

Adaption required: Dropizol^®, metoclopramide, omeprazole, pantoprazole

9 (4.3%)

Adaption not required: espumisan, granisetron, lactulose, macrogol, saccharomyces cerevisiae

Neuromuscular

Adaption required: gabapentin, galantamine, lamotrigine, levetiracetam, levodopa, Madopar^®, pramipexole, pregabalin, propiverine, venlafaxine

15 (7.17%)

Adaption not required: darifenacin, propofol, quetiapine, remifentanil, valproate

Other

Adaption not required: Helixor^®, latanoprost, letrozole, olopatadine, osimertinib, tamsulosin, timolol

7 (3.34%)

↓ **Table 3.** Differences in the Frequency of Use of Substances Requiring Dose Adjustment Between the Different Stages of CKD
Medication	P value
A P value of less than 0.05 indicates that a particular drug has not been used with comparable frequency in all stages of CKD. CKD: chronic kidney disease; ASS: Acetylsalicylic acid.
ASS	0.74
Acyclovir	0.83
Alendronate	0.72
Allopurinol	0.14
Amitriptyline	0.83
Amphotericin B	0.83
Apixaban	0.55
Cefuroxime	0.62
Chlorthalidone	0.44
Ciprofloxacin	0.13
Citalopram	0.91
Clarithromycin	0.62
Cholecalciferol	0.42
Co-trimoxazole	0.05
Diazepam	0.83
Dropizol	0.28
Enalapril	0.03
Edoxaban	0.34
Enoxaparin	0.84
Empagliflozin	0.31
Eplerenone	0.13
Epoetin alfa	< 0.001
Erythromycin	0.28
Fenoterol	0.9
Flucloxacillin	0.83
Glimepiride	0.83
Gabapentin	0.72
Gabrilen (ketoprofen)	0.83
Galantamine	0.83
Gentamicin	0.83
Heparin (high-molecular weight heparin)	< 0.001
Hydrochlorothiazide	0.5
Indapamide	0.83
Lamotrigine	0.83
Lercanidipine	0.24
Levetiracetam	0.24
Levodopa	0.72
Levofloxacin	0.7
Lisinopril	0.13
Madopar	0.02
Magnesium	0.19
Meropenem	0.13
Mesalamine	0.28
Metformin	0.016
Metoclopramide	0.7
Midazolam	0.28
Mirtazapine	0.55
Morphine	0.4
Moxonidine	0.13
Naftidrofuryl oxalate	0.83
Nebivolol	0.07
Nutriflex Peri	0.83
Olmesartan	0.21
Omeprazole	0.62
Opipramol	0.28
Oxycodone	0.63
Pantoprazole	0.06
Phenprocoumon	0.2
Piperacillin	0.02
Piracetam	0.83
Pramipexole	0.28
Pravastatin	0.72
Pregabalin	0.55
Propiverine	0.83
Propranolol	0.83
Ramipril	0.1
Risperidone	0.44
Rivaroxaban	0.49
Rosuvastatin	0.59
Sacubitril	0.62
Salbutamol	0.44
Semaglutide	0.83
Sevelamer	0.009
Simvastatin	0.69
Sitagliptin	0.08
Sodium bicarbonate	< 0.001
Sodium polystyrene sulfonate	0.38
Spironolactone	0.17
Telmisartan	0.7
Torsemide	0.37
Valganciclovir	0.28
Vancomycin	0.52
Venlafaxine	0.25
Vildagliptin	0.83

↓ Table 3. Differences in the Frequency of Use of Substances Requiring Dose Adjustment Between the Different Stages of CKD

Medication

P value

A P value of less than 0.05 indicates that a particular drug has not been used with comparable frequency in all stages of CKD. CKD: chronic kidney disease; ASS: Acetylsalicylic acid.

ASS

0.74

Acyclovir

0.83

Alendronate

0.72

Allopurinol

0.14

Amitriptyline

0.83

Amphotericin B

0.83

Apixaban

0.55

Cefuroxime

0.62

Chlorthalidone

0.44

Ciprofloxacin

0.13

Citalopram

0.91

Clarithromycin

0.62

Cholecalciferol

0.42

Co-trimoxazole

0.05

Diazepam

0.83

Dropizol

0.28

Enalapril

0.03

Edoxaban

0.34

Enoxaparin

0.84

Empagliflozin

0.31

Eplerenone

0.13

Epoetin alfa

< 0.001

Erythromycin

0.28

Fenoterol

0.9

Flucloxacillin

0.83

Glimepiride

0.83

Gabapentin

0.72

Gabrilen (ketoprofen)

0.83

Galantamine

0.83

Gentamicin

0.83

Heparin (high-molecular weight heparin)

< 0.001

Hydrochlorothiazide

0.5

Indapamide

0.83

Lamotrigine

0.83

Lercanidipine

0.24

Levetiracetam

0.24

Levodopa

0.72

Levofloxacin

0.7

Lisinopril

0.13

Madopar

0.02

Magnesium

0.19

Meropenem

0.13

Mesalamine

0.28

Metformin

0.016

Metoclopramide

0.7

Midazolam

0.28

Mirtazapine

0.55

Morphine

0.4

Moxonidine

0.13

Naftidrofuryl oxalate

0.83

Nebivolol

0.07

Nutriflex Peri

0.83

Olmesartan

0.21

Omeprazole

0.62

Opipramol

0.28

Oxycodone

0.63

Pantoprazole

0.06

Phenprocoumon

0.2

Piperacillin

0.02

Piracetam

0.83

Pramipexole

0.28

Pravastatin

0.72

Pregabalin

0.55

Propiverine

0.83

Propranolol

0.83

Ramipril

0.1

Risperidone

0.44

Rivaroxaban

0.49

Rosuvastatin

0.59

Sacubitril

0.62

Salbutamol

0.44

Semaglutide

0.83

Sevelamer

0.009

Simvastatin

0.69

Sitagliptin

0.08

Sodium bicarbonate

< 0.001

Sodium polystyrene sulfonate

0.38

Spironolactone

0.17

Telmisartan

0.7

Torsemide

0.37

Valganciclovir

0.28

Vancomycin

0.52

Venlafaxine

0.25

Vildagliptin

0.83