Dialysis initiation is associated with high rates of polypharmacy, which do not decrease over time

According to a large registry study, the use of chronic kidney disease and non-chronic kidney disease medications remains high among older patients who initiate dialysis. A majority of patients receive 10 drugs or more, while dialysis does not necessarily reduce polypharmacy.

Ms Léa Faure (University of Bordeaux, France) analysed data from the national renal replacement therapy registry (REIN), which included all patients 65 years or older who initiated chronic dialysis in France between 2010 and 2019 [1]. Drug use was determined based on reimbursed outpatient therapies, starting 1 year prior to and ending 1 year after dialysis initiation. The analysis included a total of 55,238 patients.

In the quarter preceding dialysis initiation, 76.0% of patients had hyperpolypharmacy (defined as taking ≥10 drugs), with a median of 14 drugs. Hyperpolypharmacy rates slightly declined for the first year following dialysis initiation, but remained high (>70% of patients). Overall, the use of drug classes such as antihypertensive medications (except diuretics), potassium binders, and hypouraemics tended to decrease before dialysis initiation, while the use of agents for hypercalcaemia and phosphate binders increased up to the time of dialysis. The use of non-chronic kidney disease medications (insulins, psychotropic medications, analgesics, and non-antihypertensive cardiovascular drugs such as anticoagulants and platelet aggregation inhibitors) tended to be stable in the 1 year prior to and 1 year after dialysis initiation.

The authors concluded that French older patients have several changes in their drug prescriptions leading up to their dialysis, particularly for drug regimens related to chronic kidney disease. However, the total number of drugs does not decrease after dialysis, and there is no apparent simplification of treatment regimens.

1. Faure L, et al. Impact of dialysis initiation on drug use patterns in older patients: Results from the French national renal replacement therapy registry matched with the national health data system (SNDS). 62nd ERA Congress, 4–7 June 2025, Vienna, Austria.

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Posted on 22 August 202522 August 2025