Pharmacogenomic Interactions in Antihypertensive Drug Polypharmacy and their Association with Intradialytic Complications in Chronic Kidney Disease Patients Undergoing Hemodialysis

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Published: Aug 12, 2026
DOI: https://doi.org/10.55885/jchp.v6i2.1040
Keywords:
Pharmacogenomics, Polypharmacy, Antihypertensive Drugs, Hemodialysis, Intradialytic Complications

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Chairiati
Master's Program in Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Bhakti Kencana, Bandung, Indonesia
Inge Maharani Ivo
Master's Program in Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Bhakti Kencana, Bandung, Indonesia
Rahma Ziska
Master's Program in Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Bhakti Kencana, Bandung, Indonesia

Abstract

This study aims to synthesize scientific evidence on pharmacogenomic interactions in antihypertensive drug polypharmacy and their association with intradialytic complications in patients with chronic kidney disease (CKD) undergoing hemodialysis through a Systematic Literature Review (SLR) approach. A systematic search of PubMed, Scopus, Web of Science Core Collection, Google Scholar, and Wiley Online Library was conducted for studies published from 2017 to 2025. The review was reported in accordance with PRISMA 2020, although the protocol was not prospectively registered. Evidence from maintenance hemodialysis populations was synthesized separately from contextual pharmacogenomic evidence derived from non-dialysis or mixed CKD populations. A total of 30 articles met the inclusion criteria and were synthesized narratively. The review findings indicate that antihypertensive polypharmacy is highly prevalent in the hemodialysis population, with an average use of ≥5–10 medications. The most frequently reported pharmacogenomic interactions involve phase I drug-metabolizing genes, particularly CYP2D6 and CYP2C9, which influence responses to beta-blockers and angiotensin receptor blockers (ARBs). Drug–drug–gene interactions under intensive polypharmacy conditions increase the risk of intradialytic hypotension, intradialytic hypertension, bradycardia, electrolyte disturbances, and reduced quality of life. This synthesis confirms that intradialytic complications are influenced not only by drug class or timing of administration, but also by the combination of genetic factors, kidney function, and medication burden. The integration of pharmacogenomic approaches, polypharmacy evaluation, and the involvement of clinical pharmacists has the potential to improve patient safety and hemodynamic stability in hemodialysis patients.

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How to Cite
Chairiati, C., Maharani Ivo, I., & Ziska, R. . (2026). Pharmacogenomic Interactions in Antihypertensive Drug Polypharmacy and their Association with Intradialytic Complications in Chronic Kidney Disease Patients Undergoing Hemodialysis. Journal of Community Health Provision, 6(2), 626-643. https://doi.org/10.55885/jchp.v6i2.1040
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Vol. 6 No. 2 (2026): Journal of Community Health Provision
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Articles
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This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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