Background  Patients with chronic kidney disease (CKD) are more prone to have adverse drug reaction (ADR) due to their own diseases and inappropriate medication. It is of great clinical significance to reduce inappropriate medication and to prevent ADR for CKD.

  Objective  To analyze ADRs occurred in CKD patients and the renally inappropriate medication (RIM) for providing reference to rational drug use in patients with CKD.

  Methods  ADRs reported by the nephrology department in our hospital from 2009 to 2021 were analyzed, including the basic information of patients, CKD stages, drug types, and the involved system/organs. The occurrence of RIMs in ADR reports were evaluated according to the drug instructions, relevant guidelines and expert consensus.

  Results  A total of 629 ADRs were included, including 93 severe ADRs, with a male to female ratio of 1.18:1, and they occurred most frequently in CKD with age of 40-59 years. The top three categories of ADRs were cardiovascular drugs, anti-infective drugs, electrolyte, acid-base balance and nutritional drugs. Many systemic/organs (849 cases) were involved, the top three were gastrointestinal disorders (156 cases, 18.37%), skin and appendages disorder (139 cases, 16.37%), body as a whole-general disorders (107 cases, 12.60%). A total of 61 (9.69%) RIMs were found in ADR reports, including 19 (31.15%) serious ADRs. Levofloxacin was the most common drug both of RIM and serious ADR in RIM.

  Conclusion  There are multiple drugs and systems/organs involved in ADR of CKD patients, and part of them are related to RIM. Therefore, we should strengthen medication monitoring in CKD patients and reduce RIMs, especially when we use the anti-infective, cardiovascular, and nephrotoxic drugs.