This result is in agreement with a study by Corsonello and colleagues who found an association between patient renal function and the risk of ADRs in elderly hospitalized patients. However, we also found that among ESRD, non-dialysis dependent patients were more than two times more susceptible to develop ADRs compared to hemodialysis patients. This could be because renal impairment related pharmacokinetic and pharmacodynamic changes such as a decrease in the elimination of the parent drug or of toxic metabolites, NSC 136476 alteration in drug distribution or protein binding, metabolic abnormalities, or possibly increased target organ susceptibility in uremic patients. This finding emphasizes the need to triage patients for decision regarding the initiation of renal replacement therapy. In this study, patients with a lower serum level of albumin were at increased risk of experiencing ADRs during hospital stay. This is in line with the Corsonello and colleague study, that showed an association between hypoalbuminemia in patients with concealed renal failure and ADRs. These can also be explained by the decreased binding of albumin-bound drugs, and the accumulation of the unbound fraction in plasma. In addition,Vismodegib patients with vascular disease experienced more ADRs during in hospital stay. Noticeably, patients with CKD are often excluded from coronary artery disease trials; therefore, the safety profile of cardiovascular medications in these patients is mostly based upon knowledge of postmarketing rather than controlled trials. Moreover, in our study, patients who developed ADRs had a higher serum level of CRP, and both CRP value and vascular disease remained significant predictors of developing ADRs when included simultaneously in the regression model. Possible mechanisms include a role for CRP as an inflammatory marker and the formation of atherosclerosis, and its role in the vascular diseases. The ADR risk score has important implications for clinical practice and research. For example, by using this score, lower-risk patients could be managed less extensively, whereas, higher-risk patients could receive more intensive interventions aimed at reducing drug-related adverse outcomes and improving the costeffectiveness of CKD therapy.