Potential Drug-Drug Interactions in Patients Undergoing Hemodialysis: A Retrospective Observational Study

To evaluate the prevalence, characteristics, and determinants of potential drug-drug interactions (pDDIs) among patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) at a tertiary care hospital in Al-Madinah Al-Monawara, Kingdom of Saudi Arabia.

Data for this retrospective observational study were extracted from the electronic medical records of adult patients (≥ 18 years) diagnosed with ESRD and receiving hemodialysis (HD) between October 2022 and March 2023. The pDDIs were identified and classified using Lexicomp® (Wolters Kluwer, Alphen aan den Rijn, Netherlands). Descriptive statistics summarized patient characteristics and pDDIs, and univariate logistic regression was implemented to investigate the determinants associated with the occurrence of pDDI.

Among 287 patients, 264 (92%) experienced at least 1 pDDI. In total, 4,157 pDDIs were identified, most of which were Category C (75.4%), followed by Categories B and D. Category X interactions were uncommon (n = 78), with clopidogrel-omeprazole and clopidogrel-esomeprazole being the most frequent. Patients received a mean of 14 ± 5.1 medications. Logistic regression showed that the number of prescribed medications was significantly associated with pDDI occurrence (odds ratio = 2.03; p = 0.001).

The pDDIs are highly prevalent among patients with ESRD undergoing HD, with polypharmacy identified as the main determinant. These findings highlight the importance of structured medication review, multidisciplinary collaboration, and clinical pharmacist involvement to reduce medication-related risks and optimize patient outcomes.