Assessment of Potential Drug Interactions in Patients With Chronic Kidney Disease Undergoing Hemodialysis

Background: Patients with chronic kidney disease (CKD) undergoing hemodialysis commonly present multiple comorbidities and require complex medication regimens. Polypharmacy increases the risk of clinically relevant drug interactions that may compromise treatment safety and effectiveness. Objective: To estimate the prevalence of potential drug interactions among patients with CKD undergoing hemodialysis and classify these interactions according to clinical risk and mechanism of action. Methods: A cross-sectional study was conducted with patients undergoing hemodialysis at a dialysis clinic in Southern Santa Catarina, Brazil. Potential drug interactions were identified using the Medscape and Drugs.com databases and classified according to severity (major, moderate, or minor) and mechanism of action. Results: A total of 151 patients were included. Potential drug interactions were identified in all participants (973 interactions; mean 6.4 per patient). Of these, 234 (24.0%) were classified as major, 545 (56.0%) as moderate, and 194 (19.9%) as minor. The most frequent major interactions involved furosemide + losartan (n = 8) and acetylsalicylic acid + clopidogrel (n = 6). Among moderate interactions, the most common were sevelamer + calcium carbonate (n = 14) and losartan + amlodipine (n = 12). The most frequent minor interactions involved epoetin alfa + acetylsalicylic acid (n = 14) and epoetin alfa + calcium carbonate (n = 10). Pharmacodynamic interactions predominated, mainly involving additive effects of cardiovascular medications. Conclusions: Potential drug interactions were highly prevalent among patients undergoing hemodialysis, with moderate-severity interactions predominating. Routine screening for potential drug interactions may support safer prescribing, optimize pharmacotherapy, and strengthen multidisciplinary medication management in this high-risk population.