INC900099 Supplemental Material - Supplemental material for Community prescribing of potentially nephrotoxic drugs and risk of acute kidney injury requiring renal replacement therapy in critically ill adults: A national cohort study (original) (raw)
Related papers
Journal of the Intensive Care Society, 2020
Background Acute kidney injury demonstrates a high incidence in critically ill populations, with many requiring renal replacement therapy. Patients may be at increased risk of acute kidney injury if prescribed certain potentially nephrotoxic medications. We aimed to evaluate this association in ICU survivors. Methods Study design – secondary analysis of national cohort of ICU survivors to hospital discharge linked to Scottish healthcare datasets. Outcomes: primary – renal replacement therapy in ICU; secondary – early acute kidney injury (calculated using urine output and relative change from estimated baseline serum creatinine within first 24 h of ICU admission using modified-RIFLE criteria). Primary exposure: pre-admission community prescribing of at least one potential nephrotoxin: angiotensin-converting-enzyme inhibitors/angiotensin-receptor blockers, diuretics or nonsteroidal anti-inflammatory drugs. Statistical analyses: unadjusted associations – univariable logistic regression...
Drug Dosing in Critically Ill Patients with Acute Kidney Injury and on Renal Replacement Therapy
Indian Journal of Critical Care Medicine, 2020
Acute kidney injury (AKI) complicates in around 40-50% of patients in intensive care units (ICUs), and this can account for up to 80% mortality, especially in those patients requiring renal replacement therapy (RRT). Appropriate drug dosing in such patients is a challenge to the intensivists due to various factors such as patient related (appropriate body weight, organ clearance, serum protein concentration), drug related [molecular weight (MW), protein binding, volume of distribution (V d), hydrophilicity, or hydrophobicity], and RRT related (type, modality of solute removal, filter characteristics, dose, and duration). Therapeutic drug monitoring (TDM) of drugs can be a promising solution to this complex scenario to titrate a drug to its clinical response, but it is available only for a few drugs. In this review, we discussed drug dosing aspects of antimicrobials, sedatives, and antiepileptics in critically ill patients with AKI on RRT.
Kidney International, 2009
Medication errors in patients with reduced creatinine clearance are harmful and costly; however, most studies have been conducted in large academic hospitals. As there are few studies regarding this issue in smaller community hospitals, we conducted a multicenter, retrospective cohort study in six community hospitals (100 to 300 beds) to assess the incidence and severity of adverse drug events (ADEs) in patients with reduced creatinine clearance. A chart review was performed on adult patients hospitalized during a 20-month study period with serum creatinine over 1.5 mg/dl who were exposed to drugs that are nephrotoxic or cleared by the kidney. Among 109,641 patients, 17,614 had reduced creatinine clearance, and in a random sample of 900 of these patients, there were 498 potential ADEs and 90 ADEs. Among these ADEs, 91% were preventable, 51% were serious, 44% were significant, and 4.5% were life threatening. Of the potential ADEs, 54% were serious, 44% were significant, 1.6% were life threatening, and 96.6% were not intercepted. All 82 preventable events could have been intercepted by renal dose checking. Our study shows that ADEs were common in patients with impaired kidney function in community hospitals, and many appear potentially preventable with renal dose checking.
American Journal of Kidney Diseases, 2013
Critically ill patients with acute kidney injury may be treated with a variety of renal replacement therapies (RRTs). Each of these RRTs has profound yet differing effects on drug dosing. Although the doses of some drugs can be titrated to an immediately observable pharmacodynamic effect, the effects of many drugs, such as antibiotics for example, are not immediately apparent. Attainment of desired pharmacodynamic response is a complex interplay between patient, RRT, and pharmacokinetic factors. In the case of antibiotics, microorganism-specific factors also must be considered. Rational and effective drug dosing in this clinical setting cannot occur until all these issues are addressed by the clinician. Failure to account for the pharmacokinetic influences of critical illness, kidney disease, and choice of intermittent hemodialysis or prolonged intermittent or continuous RRT can contribute to the high mortality rates seen in these patients. Pharmacotherapy considerations for each of these therapies are addressed in this article by applying them to a patient case. Am J Kidney Dis. 61 :490-500.
Clinical pharmacology and therapeutics, 2014
Acute kidney injury requiring continuous renal replacement therapy is common, costly, and associated with mortality rates of up to 60%. Accurate pharmacokinetic data are essential to developing rational individualized dosing strategies and providing optimal care to these patients, yet few such data exist, probably due in part to an absence of regulatory guidance on the issue. The Kidney Health Initiative is working with stakeholders to propose strategies to address this in a standardized manner.
Drug-Associated Renal Dysfunction
Critical Care Clinics, 2006
The development of acute renal failure (ARF) that requires renal replacement therapy is one of the most catastrophic events that can occur in a critically ill patient. ARF occurs in approximately 6% of patients in the ICU [1]. The mortality of patients in the ICU who require any type of renal replacement is greater than 50% [1]; this rate has not changed since the advent of dialysis [2]. Preexisting renal disease and left ventricular dysfunction have been identified as risk factors for the development of ARF . Although clinicians recognize the seriousness of ARF in the ICU, little has been done to assess the overall contribution that pharmacotherapy has on the development of ARF. Sepsis generally is regarded as the most common cause of ARF in the ICU [4], but clinicians recognize that drug therapies are important contributors to renal dysfunction in the ICU. One small case series estimated that up to 14% of all cases of ARF in the ICU were caused by drugs . It is difficult to determine the overall contribution of drug-induced renal dysfunction in the ICU because of the complexity of critically ill patients. Many of the essential drugs in the ICU (eg, antibiotics, vasopressors, intravenous contrast dye) are widely known to be nephrotoxic, yet they continue to be used because less toxic agents are unavailable or are less effective. To determine how often potentially nephrotoxic drugs are used in the ICUs in the authors' own institution, a brief drug use evaluation was conducted.
PeerJ, 2018
Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital. This is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (S) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression. Overall, 122 participants were included in the study. Median age was 46.0 (interquartile range, I...
Pharmaceuticals
To determine whether non-steroidal anti-inflammatory drug (NSAIDs) exposure prior to intensive care unit (ICU) admission affects the development of acute kidney injury (AKI) with renal replacement therapy (RRT). An administrative database is used to establish a cohort of patients who were admitted to the ICU. The exposure to NSAIDs that the patients had before admission to the ICU is determined. Demographic variables, comorbidities, AKI diagnoses requiring RRT, and pneumonia during the ICU stay are also measured. Multivariate logistic regression and inverse probability weighting (IPW) are used to calculate risks of exposure to NSAIDs for patients with AKI requiring RRT. In total, 96,235 patients were admitted to the ICU, of which 16,068 (16.7%) were exposed to NSAIDs. The incidence of AKI with RRT was 2.71% for being exposed to NSAIDs versus 2.24% for those not exposed (p < 0.001). For the outcome of AKI, the odds ratio weighted with IPW was 1.28 (95% CI: 1.15–1.43), and for the ...
World Journal of Advanced Research and Reviews
Introduction: Drug-induced acute kidney injury (AKI) is a significant cause of morbidity and mortality, accounting for 8% to 60% of in-hospital AKI cases. Impaired renal function leads to the accumulation of drugs and their metabolites in the body, increasing the nephrotoxic burden and the risk of AKI. Objective: The study aims to assess the necessity of appropriate dosage adjustment in patients with acute kidney injury (AKI) and the utilization of previously nephrotoxic drugs. Method: A prospective observational study was conducted among Acute Kidney Injury patients for a period of about 6 months. The collected data were analyzed using SPSS v.20. Pearson’s chi-square tests, correlation, and linear regression analysis were employed to examine the collected data. Results: A study of 207 patients revealed that 97% were prescribed antibiotics, with penicillin being the most common (46.9%). Cephalosporin and piperacillin/tazobactam were prescribed to 38.80% and 37.81% of patients, respe...
The role of medications and their management in acute kidney injury
Integrated Pharmacy Research and Practice, 2015
Prior to 2002, the incidence of acute renal failure (ARF) varied as there was no standard definition. To better understand its incidence and etiology and to develop treatment and prevention strategies, while moving research forward, the Acute Dialysis Quality Initiative workgroup developed the RIFLE (risk, injury, failure, loss, end-stage kidney disease) classification. After continued data suggesting that even small increases in serum creatinine lead to worse outcomes, the Acute Kidney Injury Network (AKIN) modified the RIFLE criteria and used the term acute kidney injury (AKI) instead of ARF. These classification and staging systems provide the clinician and researcher a starting point for refining the understanding and treatment of AKI. An important initial step in evaluating AKI is determining the likely location of injury, generally classified as prerenal, renal, or postrenal. There is no single biomarker or test that definitively defines the mechanism of the injury. Identifying the insult(s) requires a thorough assessment of the patient and their medical and medication histories. Prerenal injuries arise primarily due to renal hypoperfusion. This may be the result of systemic or focal conditions or secondary to the effects of drugs such as nonsteroidal anti-inflammatory drugs, calcineurin inhibitors (CIs), and modulators of the renin-angiotensin-aldosterone system. Renal, or intrinsic, injury is an overarching term that represents complex conditions leading to considerable damage to a component of the intrinsic renal system (renal tubules, glomerulus, vascular structures, interstitium, or renal tubule obstruction). Acute tubular necrosis and acute interstitial nephritis are the more common types of intrinsic renal injury. Each type of injury has several drugs that are implicated as a possible cause, with antiinfectives being the most common. Postrenal injuries that result from obstruction block the flow of urine, leading to hydronephrosis and subsequent damage to the renal parenchyma. Drugs associated with tubular obstruction include acyclovir, methotrexate, and several antiretrovirals. Renal recovery from drug-induced AKI begins once the offending agent has been removed, if clinically possible, and is complete in most cases. It is uncommon that renal replacement therapy will be needed while recovery occurs. Pharmacists can play a pivotal role in identifying possible causes of drug-induced AKI and limit their toxic effect by identifying those most likely to cause or contribute to injury. Dose adjustment is critical during changes in renal function, and the pharmacist can ensure that optimal therapy is provided during this critical time.