Medication Burden and Clinical Outcomes in Dialysis Patients: A Systematic Review and Meta-Analysis

Polypharmacy is common among dialysis patients, but its independent impact on clinical outcomes-beyond the influence of comorbidities-has not been specifically quantified in this population. This systematic review and meta-analysis aimed to determine whether a higher medication burden is associated with worse clinical and patient-reported outcomes among dialysis patients.

Searches of MEDLINE, Scopus, Cochrane CENTRAL, Thai, and grey literature sources were conducted until 28 February 2026. Eligible studies enrolled adults on dialysis, assessed medication or pill burden as the exposure, and reported predefined outcomes. Two independent reviewers collected data and evaluated risk of bias with ROBINS-I, ROBINS-E, or the Modified Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted using REML estimation.

Sixteen studies were analyzed. Polypharmacy showed a significant association to all-cause mortality in both per-medication dose-response (HR = 1.07; 95% CI 1.03-1.10; I ² = 93.55%) and categorical analyses (HR = 1.10; 95% CI 1.02-1.18; I ² = 89.66%). Polypharmacy was associated with medication nonadherence (OR = 1.08; 95% CI 1.04-1.13) and poorer quality of life. Hospitalization data were inadequate for pooling because outcome definitions varied.

In dialysis patients, higher medication burden is associated with increased mortality, nonadherence, and reduced quality of life. Although routine medication reviews and deprescribing are recommended, further research is needed to confirm causality and effectiveness.