{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:11:38Z","timestamp":1789017098347,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Chronic kidney disease (CKD) affects more than 10% of the global population and represents one of the leading causes of mortality. This study aimed to assess the pharmacotherapy of hospitalized patients aged \u2265 65 years with CKD, focusing on the prevalence of polypharmacy, potentially inappropriate medications (PIMs), potentially clinically significant drug\u2013drug interactions (DDIs), the use of renal-risk drugs (RRDs). A prospective observational study was conducted at the Department of Nephrology and Dialysis of University Hospital Dubrava, including 100 participants. A clinical pharmacist obtained the Best Possible Medication History (BPMH) within 24 h of hospital admission. A total of 1324 comorbidities were recorded (median 12 per patient), along with 985 prescribed medications. Polypharmacy (5\u20139 drugs) was observed in 43% of patients, while excessive polypharmacy (\u226510 drugs) was present in 48%. A total of 258 PIMs were identified, with 89% of patients having at least one PIM (mean 2.6 per patient). Nearly 94% of patients had significantly impaired renal function (G3\u2013G5), and 82% were exposed to inappropriately prescribed RRDs. Contraindicated medications based on renal function were identified in 62% of patients, while 52% had at least one medication prescribed at an unadjusted dose. A total of 1097 potentially clinically significant DDIs were identified, with a mean of 10.9 interactions per patient. The results indicate a high prevalence of polypharmacy, PIMs, potentially clinically significant DDIs and inappropriately prescribed RRDs among older hospitalized patients with CKD, increasing the risk of adverse events and unfavorable treatment outcomes. The findings highlight the importance of the 24 h period following hospital admission as an early opportunity for identifying medication-related problems and optimizing pharmacotherapy in highly vulnerable patients, such as elderly patients with CKD. The study also emphasizes the importance of early involvement of a clinical pharmacist in the pharmacotherapy review and obtaining the BPMH.<\/jats:p>","DOI":"10.3390\/pharmacy14060130","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:07:32Z","timestamp":1788538052000},"page":"130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The First 24 Hours of Hospital Admission: Early Opportunity for Pharmacotherapy Optimization in Elderly Patients with Chronic Kidney Disease"],"prefix":"10.3390","volume":"14","author":[{"given":"Ana","family":"Mulej","sequence":"first","affiliation":[{"name":"Hospital Pharmacy, Clinical Hospital Center of Rijeka, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Marinovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iva","family":"Matkovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesna Ba\u010di\u0107","family":"Vrca","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luka","family":"Tori\u0107","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8858-4789","authenticated-orcid":false,"given":"Dino","family":"Kasumovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matija","family":"Crnogorac","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Dialysis, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9050-5747","authenticated-orcid":false,"given":"Ivica","family":"Horvati\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia"},{"name":"Department of Nephrology and Dialysis, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Samard\u017ei\u0107","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: An update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int. Suppl."},{"key":"ref_2","unstructured":"Vaidya, S.R., and Aeddula, N.R. (2024, July 31). Chronic Kidney Disease, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK535404\/."},{"key":"ref_3","unstructured":"Croatian Institute of Public Health (2026, June 23). World Kidney Day. Available online: https:\/\/www.hzjz.hr\/aktualnosti\/svjetski-dan-bubrega-14-ozujka-2024\/."},{"key":"ref_4","unstructured":"Australian Institute of Health and Welfare (2026, July 14). Chronic Kidney Disease: Australian Facts, Available online: https:\/\/www.aihw.gov.au\/reports\/chronic-kidney-disease\/chronic-kidney-disease\/contents\/summary."},{"key":"ref_5","unstructured":"World Health Organization (2026, June 23). Ageing and Health. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/ageing-and-health."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100020","DOI":"10.1016\/j.crphar.2021.100020","article-title":"Drug-drug interactions in polypharmacy patients: The impact of renal impairment","volume":"2","author":"Papotti","year":"2021","journal-title":"Curr. Res. Pharmacol. Drug Discov."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kurczewska-Michalak, M., Lewek, P., Jankowska-Pola\u0144ska, B., Giardini, A., Granata, N., Maffoni, M., Costa, E., Mid\u00e3o, L., and Kardas, P. (2021). Polypharmacy management in older adults: A scoping review of available interventions. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.734045"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1093\/ndt\/gfh280","article-title":"Medication prescribing patterns in ambulatory haemodialysis patients: Comparisons of USRDS to a large not-for-profit dialysis provider","volume":"19","author":"Manley","year":"2004","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s00228-015-1860-9","article-title":"The EU(7)-PIM list: A list of potentially inappropriate medications for older people consented by experts from seven European countries","volume":"71","author":"Meyer","year":"2015","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1017\/S0714980819000084","article-title":"Reducing potentially inappropriate medications in older adults: A way forward","volume":"38","author":"Bala","year":"2019","journal-title":"Can. J. Aging"},{"key":"ref_11","first-page":"105","article-title":"Polytherapy and drug interactions in elderly","volume":"7","author":"Gujjarlamudi","year":"2016","journal-title":"J. Midlife Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e70037","DOI":"10.1111\/fcp.70037","article-title":"Drug exposure in chronic kidney disease: It is not just about the glomerular filtration rate","volume":"39","author":"Liabeuf","year":"2025","journal-title":"Fundam. Clin. Pharmacol."},{"key":"ref_13","first-page":"309","article-title":"Nefrotoksi\u010dni lijekovi","volume":"70","year":"2016","journal-title":"Acta Med. Croat."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.2215\/CJN.02050309","article-title":"Renal vulnerability to drug toxicity","volume":"4","author":"Perazella","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s40266-026-01299-5","article-title":"Hospitalisation as an Opportunity to Optimise Quality Use of Medicines in Older Adults: A Systematic Review","volume":"43","author":"Ucarer","year":"2026","journal-title":"Drugs Aging"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"(2024). Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_17","unstructured":"Croatian Agency for Medicinal Products and Medical Devices (2026, August 26). Medicinal Products Database. Available online: https:\/\/www.halmed.hr\/lijekovi\/baza-lijekova\/."},{"key":"ref_18","unstructured":"National Institute for Health and Care Excellence (2026, August 26). Medicines Optimisation. Available online: https:\/\/www.nice.org.uk\/guidance\/qs120\/chapter\/quality-statement-4-medicines-reconciliation-in-acute-settings."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"841","DOI":"10.34067\/KID.0000000000000447","article-title":"Polypharmacy in patients with CKD: A systematic review and meta-analysis","volume":"5","author":"Verhaar","year":"2024","journal-title":"Kidney360"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Naseralallah, L., Khatib, M., Al-Khulaifi, A., and Danjuma, M. (2023). Prevalence and global trends of polypharmacy in patients with chronic kidney disease: A systematic review and meta-analysis. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1122898"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J., Chowdhury, M., and Seitz, D.P. (2022). Prevalence and factors associated with polypharmacy: A systematic review and meta-analysis. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03279-x"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1159\/000526326","article-title":"Impact of potentially inappropriate medications on kidney function in chronic kidney disease: Retrospective cohort study","volume":"147","author":"Kimura","year":"2023","journal-title":"Nephron"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"42","DOI":"10.5414\/CN110808","article-title":"Potentially inappropriate medication in patients with chronic kidney disease and elderly patients","volume":"98","author":"Scheuch","year":"2022","journal-title":"Clin. Nephrol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4274\/tjps.galenos.2021.94556","article-title":"Potentially inappropriate medication use in older adults with chronic kidney disease","volume":"19","year":"2022","journal-title":"Turk. J. Pharm. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00198-015-3365-x","article-title":"Proton-pump inhibitors and risk of fractures: An updated meta-analysis","volume":"27","author":"Zhou","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1038\/ajg.2012.200","article-title":"The relationship between proton pump inhibitor use and longitudinal change in bone mineral density: A population-based study from the Canadian Multicentre Osteoporosis Study (CaMos)","volume":"107","author":"Targownik","year":"2012","journal-title":"Am. J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.ajg.2024.07.001","article-title":"The silent epidemic: Inappropriate use of proton pump inhibitors among hospitalized patients","volume":"25","author":"Mohamed","year":"2024","journal-title":"Arab J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wu, C.C., Liao, M.H., Kung, W.M., and Wang, Y.C. (2023). Proton pump inhibitors and risk of chronic kidney disease: Evidence from observational studies. J. Clin. Med., 12.","DOI":"10.3390\/jcm12062262"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1001\/jamainternmed.2015.7193","article-title":"Proton pump inhibitor use and the risk of chronic kidney disease","volume":"176","author":"Lazarus","year":"2016","journal-title":"JAMA Intern. Med."},{"key":"ref_30","first-page":"354","article-title":"Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline","volume":"63","author":"Farrell","year":"2017","journal-title":"Can. Fam. Physician"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s40266-018-0593-8","article-title":"The role of deprescribing in older adults with chronic kidney disease","volume":"35","author":"Triantafylidis","year":"2018","journal-title":"Drugs Aging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"183","DOI":"10.31128\/AJGP-11-20-5752","article-title":"Prescribing and deprescribing in chronic kidney disease","volume":"50","author":"McMorrow","year":"2021","journal-title":"Aust. J. Gen. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1111\/jgs.13790","article-title":"Use of renally inappropriate medications in older veterans: A national study","volume":"63","author":"Chang","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s40266-015-0261-1","article-title":"Potentially inappropriate prescribing of renally cleared drugs in elderly patients in community and aged care settings","volume":"32","author":"Khanal","year":"2015","journal-title":"Drugs Aging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1053\/j.ajkd.2021.02.342","article-title":"Principles of kidney pharmacotherapy for the nephrologist: Core Curriculum 2021","volume":"78","author":"Vondracek","year":"2021","journal-title":"Am. J. Kidney Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1053\/j.ackd.2010.06.004","article-title":"Medication-related problems in CKD","volume":"17","author":"Cardone","year":"2010","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1177\/87551225241241977","article-title":"Clinical pertinence and determinants of potential drug-drug interactions in chronic kidney disease patients: A cross-sectional study","volume":"40","author":"Khanna","year":"2024","journal-title":"J. Pharm. Technol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"25","DOI":"10.33545\/26647184.2024.v6.i1a.27","article-title":"Assessment of drug-drug interactions in patients with chronic kidney disease","volume":"6","author":"Shazia","year":"2024","journal-title":"Int. J. Pharmacol. Pharm. Res."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Samard\u017ei\u0107, I., Marinovi\u0107, I., Marovi\u0107, I., Ku\u010da, N., and Ba\u010di\u0107 Vrca, V. (2025). Pharmacist intervention models in drug-drug interaction management in prescribed pharmacotherapy. Pharmacy, 13.","DOI":"10.3390\/pharmacy13060167"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"91","DOI":"10.31083\/ph.2024.3666","article-title":"Effect of care transfer model led by the hospital clinical pharmacist on reduction of hospital readmissions in the elderly","volume":"79","author":"Jambrek","year":"2024","journal-title":"Pharmazie"}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/6\/130\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:42:34Z","timestamp":1789015354000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/6\/130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["pharmacy14060130"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy14060130","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}