Research Article | Volume: 15, Issue: 7, July, 2025

Prescribing patterns of nutritional supplements in hemodialysis patients: Insights from a multi-centric study in Karnataka, India

Gangadhar Naik Jarupala,  Sreedhar Dharmagadda,  Virendra Ligade Siddaram,  Shankar Prasad Nagaraju,  Manjunath Kulkarni   

Gangadhar Naik Jarupala1,2, Sreedhar Dharmagadda3, Virendra Ligade Siddaram3, Shankar Prasad Nagaraju4, Manjunath Kulkarni5

1Department of Pharmaceutical Regulatory Affairs, ICMR, SRF Fellow, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.

2Sri Venkateshwara College of Pharmacy, Chittoor, India.

3Department of Pharmaceutical Regulatory Affairs and Management, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.

4Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.

5Department of Nephrology, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, Mangalore, India.

Open Access   

Published:  Jun 05, 2025

DOI: 10.7324/JAPS.2025.224915
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Abstract

Multivitamins, multi-minerals, hematinics, and dietary supplements (MMHDSs) are commonly prescribed to hemodialysis (HD) patients to mitigate the risk of nutrient deficiencies. This cross-sectional, multi-centric study analyzes MMHDS prescribing patterns among HD patients. Patient demographics, medical history, and dialysis-related data were collected. Findings reveal a high prevalence of MMHDS prescriptions, with diverse supplement types, including water-soluble vitamins and essential minerals. Prescription trends were influenced by factors such as patient age, comorbidities, and dialysis duration. The study highlights variations in MMHDS prescribing practices across different centers, emphasizing the need for personalized dietary therapy. Supplements are commonly prescribed to address nutrient deficiencies, manage chronic kidney disease complications, and improve overall well-being. The findings of the study are crucial for nephrologists, clinical pharmacists, and dietitians in optimizing patient care and minimizing risks. Understanding MMHDS prescription trends enables healthcare providers to tailor interventions and enhance treatment outcomes. The study underscores the importance of evidence-based guidelines to ensure safe and effective supplement use in HD patients. Future research should explore the long-term impact of these prescribing patterns on health outcomes, dietary balance, and quality of life, ultimately improving patient care and well-being.


Keyword:     Hemodialysis multivitamins multi-minerals dietary supplements prescribing patterns renal dysfunction South Karnataka India

Citation:

Jarupala GN, Dharmagadda S, Siddaram VL, Nagaraju SP, Kulkarni M. Prescribing patterns of nutritional supplements in hemodialysis patients: Insights from a multi-centric study in Karnataka, India. J Appl Pharm Sci. 2025;15(07):220–234. https://doi.org/10.7324/JAPS.2025.224915

Copyright: © The Author(s). This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Reference

1. Jankowska M, Szupryczynska N, Debska-Slizien A, Borek P, Kaczkan M, Rutkowski B, et al. Dietary intake of vitamins in different options of treatment in chronic kidney disease: is there a deficiency? Transplant Proc. 2016;48(5):1427–30. doi: https://doi.org/10.1016/j.transproceed.2015.11.039

2. Steiber AL, Kopple JD. Vitamin status and needs for people with stages 3-5 chronic kidney disease. J Ren Nutr. 2011;21(5):355–68. doi: https://doi.org/10.1053/j.jrn.2010.12.004

3. Jakimowicz-Tylicka M, Chmielewski M, Kuzmiuk-Glembin I, Skonieczny P, Dijakiewicz G, Zdrojewska G, et al. Dietary supplement use among patients with chronic kidney disease. Acta Biochim Pol. 2018;65(2):319–24. doi: https://doi.org/10.18388/abp.2018_2578

4. Tucker BM, Safadi S, Friedman AN. Is routine multivitamin supplementation necessary in US chronic adult hemodialysis patients? A systematic review. J Ren Nutr. 2015;25(3):257–64. doi: https://doi.org/10.1053/j.jrn.2014.09.003

5. Makoff R. Vitamin replacement therapy in renal failure patients. Miner Electrolyte Metab. 1999;25(4–6):349–51. doi: https://doi. org/10.1159/000057473

6. Waxman S, Corcino JJ, Herbert V. Drugs, toxins and dietary amino acids affecting vitamin B12 or folic acid absorption or utilization. Am J Med. 1970;48(5):599–608. doi: https://doi.org/10.1016/0002- 9343(70)90010-0

7. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1–153. doi: https://doi.org/10.1053/j.ajkd.2005.01.019

8. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009;113:S1–130. doi: https://doi.org/10.1038/ki.2009.188

9. Goldsmith DJ, Covic A, Fouque D, Locatelli F, Olgaard K, Rodriguez M, et al. Endorsement of the kidney disease improving global outcomes (KDIGO) chronic kidney disease-mineral and bone disorder (CKD-MBD) guidelines: a european renal best practice (ERBP) commentary statement. Nephrol Dial Transplant. 2010;25(12):3823– 31. doi: https://doi.org/10.1093/ndt/gfq513

10. Fissell RB, Bragg-Gresham JL, Gillespie BW, Goodkin DA, Bommer J, Saito A, et al. International variation in vitamin prescription and association with mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004;44(2):293–9. doi: https://doi.org/10.1053/j.ajkd.2004.04.047

11. Bossola M, Di Stasio E, Viola A, Leo A, Carlomagno G, Monteburini T, et al. Dietary intake of trace elements, minerals, and vitamins of patients on chronic hemodialysis. Int Urol Nephrol. 2014;46(4):809– 15. doi: https://doi.org/10.1007/s11255-014-0689-y

12. Bossola M, Tazza L, Giungi S, Luciani G. Anorexia in hemodialysis patients: an update. Kidney Int. 2006;70(3):417–22. doi: https://doi.org/10.1038/sj.ki.500157

13. Kalantar-Zadeh K, Kopple JD. Trace elements and vitamins in maintenance dialysis patients. Adv Ren Replace Ther. 2003;10(3):170–82. doi: https://doi.org/10.1053/j.arrt.2003.09.002

14. Marumo F, Kamata K, Okubo M. Deranged concentrations of water-soluble vitamins in the blood of undialyzed and dialyzed patients with chronic renal failure. Int J Artif Organs. 1986;9(1):17–24. doi: https://doi.org/10.1177/03913988860090010

15. Tonelli M, Wiebe N, Hemmelgarn B, Klarenbach S, Field C, Manns B, et al. Trace elements in hemodialysis patients: a systematic review and meta-analysis. BMC Med. 2009;7:25. doi: https://doi.org/10.1186/1741-7015-7-25

16. Kasama R, Koch T, Canals-Navas C, Pitone JM. Vitamin B6 and hemodialysis: the impact of high-flux/high-efficiency dialysis and review of the literature. Am J Kidney Dis. 1996;27(5):680–6. doi: https://doi.org/10.1016/s0272-6386(96)90103-1

17. Clarke R, Daly L, Robinson K, Naughten E, Cahalane S, Fowler B, et al. Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med. 1991;324(17):1149–55. doi: https://doi.org/10.1056/NEJM199104253241701

18. Moustapha A, Naso A, Nahlawi M, Gupta A, Arheart KL, Jacobsen DW, et al. Prospective study of hyperhomocysteinemia as an adverse cardiovascular risk factor in end-stage renal disease. Circulation. 1998;97(2):138–41. doi: https://doi.org/10.1161/01.cir.97.2.138

19. Perna AF, Castaldo P, Ingrosso D, De Santo NG. Homocysteine, a new cardiovascular risk factor, is also a potent uremic toxin. J Nephrol. 1999;12(4):230–40.

20. Robinson K, Gupta A, Dennis V, Arheart K, Chaudhary D, Green R, et al. Hyperhomocysteinemia confers an independent increased risk of atherosclerosis in end-stage renal disease and is closely linked to plasma folate and pyridoxine concentrations. Circulation. 1996;94(11):2743–8. doi: https://doi.org/10.1161/01.cir.94.11.2743

21. Sunder-Plassmann G, Födinger M, Buchmayer H, Papagiannopoulos M, Wojcik J, Kletzmayr J, et al. Effect of high dose folic acid therapy on hyperhomocysteinemia in hemodialysis patients: results of the Vienna multicenter study. J Am Soc Nephrol. 2000;11(6):1106–16. doi: https://doi.org/10.1681/ASN.V1161106

22. Tremblay R, Bonnardeaux A, Geadah D, Busque L, Lebrun M, Ouimet D, et al. Hyperhomocysteinemia in hemodialysis patients: effects of 12-month supplementation with hydrosoluble vitamins. Kidney Int. 2000;58(2):851–8. doi: https://doi.org/10.1046/j.1523-1755.2000.00234.x

23. Elian KM, Hoffer LJ. Hydroxocobalamin reduces hyperhomocysteinemia in end-stage renal disease. Metabolism. 2002;51(7):881–6. doi: https://doi.org/10.1053/meta.2002.32800

24. Kaplan LN, Mamer OA, Hoffer LJ. Parenteral vitamin B12 reduces hyperhomocysteinemia in end-stage renal disease. Clin Invest Med. 2001;24(1):5–11.

25. Billion S, Tribout B, Cadet E, Queinnec C, Rochette J, Wheatley P, et al. Hyperhomocysteinaemia, folate, and vitamin B12 in unsupplemented haemodialysis patients: effect of oral therapy with folic acid and vitamin B12. Nephrol Dial Transplant. 2002;17(3):455– 61. doi: https://doi.org/10.1093/ndt/17.3.455

26. Abhisek PA, Panda R, Samal R, Mohapatra N, Mohanty S. Drug utilisation pattern and adverse events in patients with chronic kidney disease undergoing maintenance haemodialysis at a tertiary care hospital of Odisha. JCDR. 2017;11(10):FC11–6. doi: https://doi.org/10.7860/JCDR/2017/25444.10793

27. Narayana Murthy BV, Satyanarayana V. Prescribing pattern of drugs in chronic kidney disease patients on hemodialysis at a tertiary care hospital. Int J Basic Clin Pharmacol. 2017;6(4):928–32. doi: https://doi.org/10.18203/2319-2003.ijbcp20171106

28. Battistella M, Jandoc R, Ng JY, McArthur E, Garg AX. A province-wide, cross-sectional study of demographics and medication use of patients in hemodialysis units across Ontario. Can J Kidney Health Dis. 2018;5:1–10. doi: https://doi.org/10.1177/2054358118760832

29. Bajait CS, Pimpalkhute SA, Sontakke SD, Jaiswal KM, Dawri AV. Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders. Indian J Pharmacol. 2014;46(1):35– 9. doi: https://doi.org/10.4103/0253-7613.125163

30. Oommen JM, Nerurkar DP, Sajith M, Jawale S, Ambike S. Prescription pattern of chronic kidney disease patients undergoing hemodialysis in tertiary and private hospital. J Young Pharm 2019;11(2):202–6. doi: https://doi.org/10.5530/jyp.2019.11.42

31. Tadvi NA, Hussain S. Analysis of prescription pattern in patients on maintenance hemodialysis. Indian J Pharm Pharmacol 2020;7(2):125– 9. doi: https://doi.org/10.18231/j.ijpp.2020.021

32. Konduru SS, Kumar JN, Siva KL, Girija K. Assessment of drug use patterns and quality of life in hemodialysis patients. EJPMR. 2018;5(6):628–37.

33. Pothen C, Baby B, Ashokan A, Chacko C, Shenoy P, Nandakumar UP. Drug usage pattern in chronic kidney disease patients undergoing maintenance hemodialysis. Res J Pharm and Tech 2019;12(10):5024– 8. doi: https://doi.org/10.5958/0974-360X.2019.00872.2

34. Anil A, Joseph J, Varghese MA, Chacko S, Abraham E. Assessment of the prescription pattern of drugs used in chronic kidney disease patients undergoing haemodialysis in a tertiary care hospital. IAJPR. 2020;10(4):681–8.

35. Chundu S, Kaki H, Karyamsetty D, Midathana S, Krishna R, Kommanaboina H, et al. Prescribing patterns of medicines and medication adherence in CKD patients on maintenance of hemodialysis. IJPPR. 2018;12(3):251–64.

36. Raja V, Palatty PL, Sajan S, Abraham S, George T, D’Silva P, et al. Drug?prescribing pattern in chronic kidney disease patients on maintenance haemodialysis and audit of cardiovascular complications in them: pilot study from a tertiary care hospital. Hamdan Med J. 2020;13(2):88–92. doi: https://doi.org/10.4103/HMJ.HMJ_61_19

37. Kumar CR, Jyotsna B, Jaya D. A descriptive analysis of prescribing patterns of drugs in chronic kidney disease patients on maintenance hemodialysis. JMSCR. 2019;7(5):785–92. doi: https://doi.org/10.18535/jmscr/v7i5.126

38. Chakraborty S, Ghosh S, Banerjea A, De RR, Hazra A, Mandal SK. Prescribing patterns of medicines in chronic kidney disease patients on maintenance hemodialysis. Indian J Pharmacol. 2016;48(5):586– 90. doi: https://doi.org/10.4103/0253-7613.190760

39. Al-Ramahi R. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia. Saudi J Kidney Dis Transpl. 2012;23(2):403–8. doi: https://doi.org/10.4103/1319-2442.93191

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