Nephrotoxic drug burden among 1001 critically ill patients: impact on acute kidney injury.
Acute [MeSH]
Aminoglycosides [MeSH]
Contrast media [MeSH]
Diuretics [MeSH]
Intensive-care units [MeSH]
Kidney tubular necrosis
Renal insufficiency [MeSH]
Vancomycin [MeSH]
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
23 Sep 2019
23 Sep 2019
Historique:
received:
25
06
2019
accepted:
16
09
2019
entrez:
25
9
2019
pubmed:
25
9
2019
medline:
25
9
2019
Statut:
epublish
Résumé
Nephrotoxic drug prescription may contribute to acute kidney injury (AKI) occurrence and worsening among critically ill patients and thus to associated morbidity and mortality. The objectives of this study were to describe nephrotoxic drug prescription in a large intensive-care unit cohort and, through a case-control study nested in the prospective cohort, to evaluate the link of nephrotoxic prescription burden with AKI. Six hundred and seventeen patients (62%) received at least one nephrotoxic drug, among which 303 (30%) received two or more. AKI was observed in 609 patients (61%). A total of 351 patients were considered as cases developing or worsening AKI a given index day during the first week in the intensive-care unit. Three hundred and twenty-seven pairs of cases and controls (patients not developing or worsening AKI during the first week in the intensive-care unit, alive the case index day) matched on age, chronic kidney disease, and simplified acute physiology score 2 were analyzed. The nephrotoxic burden prior to the index day was measured in drug.days: each drug and each day of therapy increasing the burden by 1 drug.day. This represents a semi-quantitative evaluation of drug exposure, potentially easy to implement by clinicians. Nephrotoxic burden was significantly higher among cases than controls: odds ratio 1.20 and 95% confidence interval 1.04-1.38. Sensitivity analysis showed that this association between nephrotoxic drug prescription in the intensive-care unit and AKI was predominant among the patients with lower severity of disease (simplified acute physiology score 2 below 48). The frequently observed prescription of nephrotoxic drugs to critically ill patients may be evaluated semi-quantitatively through computing drug.day nephrotoxic burden, an index significantly associated with subsequent AKI occurrence, and worsening among patients with lower severity of disease.
Sections du résumé
BACKGROUND
BACKGROUND
Nephrotoxic drug prescription may contribute to acute kidney injury (AKI) occurrence and worsening among critically ill patients and thus to associated morbidity and mortality. The objectives of this study were to describe nephrotoxic drug prescription in a large intensive-care unit cohort and, through a case-control study nested in the prospective cohort, to evaluate the link of nephrotoxic prescription burden with AKI.
RESULTS
RESULTS
Six hundred and seventeen patients (62%) received at least one nephrotoxic drug, among which 303 (30%) received two or more. AKI was observed in 609 patients (61%). A total of 351 patients were considered as cases developing or worsening AKI a given index day during the first week in the intensive-care unit. Three hundred and twenty-seven pairs of cases and controls (patients not developing or worsening AKI during the first week in the intensive-care unit, alive the case index day) matched on age, chronic kidney disease, and simplified acute physiology score 2 were analyzed. The nephrotoxic burden prior to the index day was measured in drug.days: each drug and each day of therapy increasing the burden by 1 drug.day. This represents a semi-quantitative evaluation of drug exposure, potentially easy to implement by clinicians. Nephrotoxic burden was significantly higher among cases than controls: odds ratio 1.20 and 95% confidence interval 1.04-1.38. Sensitivity analysis showed that this association between nephrotoxic drug prescription in the intensive-care unit and AKI was predominant among the patients with lower severity of disease (simplified acute physiology score 2 below 48).
CONCLUSIONS
CONCLUSIONS
The frequently observed prescription of nephrotoxic drugs to critically ill patients may be evaluated semi-quantitatively through computing drug.day nephrotoxic burden, an index significantly associated with subsequent AKI occurrence, and worsening among patients with lower severity of disease.
Identifiants
pubmed: 31549274
doi: 10.1186/s13613-019-0580-1
pii: 10.1186/s13613-019-0580-1
pmc: PMC6757082
doi:
Types de publication
Journal Article
Langues
eng
Pagination
106Références
JAMA. 2005 Aug 17;294(7):813-8
pubmed: 16106006
Antimicrob Agents Chemother. 2016 Apr 22;60(5):3248
pubmed: 26926627
Antimicrob Agents Chemother. 2014 Dec;58(12):7468-74
pubmed: 25288085
Curr Opin Crit Care. 2016 Dec;22(6):542-545
pubmed: 27661440
Medicine (Baltimore). 2017 Feb;96(7):e6023
pubmed: 28207512
Intensive Care Med. 2017 Jun;43(6):785-794
pubmed: 28197679
Kidney Int. 2012 Jun;81(12):1172-8
pubmed: 21124300
Proc R Soc Med. 1965 May;58:295-300
pubmed: 14283879
Intensive Care Med. 2017 Jun;43(6):829-840
pubmed: 28444409
J Crit Care. 2013 Oct;28(5):687-94
pubmed: 23845794
Crit Care Med. 2018 Jan;46(1):12-20
pubmed: 29088001
J Am Soc Nephrol. 2004 Jun;15(6):1597-605
pubmed: 15153571
Kidney Int. 2004 Oct;66(4):1613-21
pubmed: 15458458
Intensive Care Med. 2015 Aug;41(8):1411-23
pubmed: 26162677
J Clin Invest. 2014 Jun;124(6):2355-63
pubmed: 24892710
N Engl J Med. 2014 Jul 3;371(1):58-66
pubmed: 24988558
Br J Clin Pharmacol. 1985 Feb;19(2):191-201
pubmed: 3986077
Expert Opin Drug Saf. 2008 Nov;7(6):679-90
pubmed: 18983215
Ren Fail. 2011;33(8):758-64
pubmed: 21777176
Intensive Care Med. 2009 Oct;35(10):1692-702
pubmed: 19547955
Crit Care Med. 2014 Apr;42(4):878-85
pubmed: 24201174
Crit Care Med. 2017 Jul;45(7):e745-e746
pubmed: 28622245
Crit Care. 2011;15(3):R135
pubmed: 21645384
Curr Opin Crit Care. 2005 Dec;11(6):555-65
pubmed: 16292059
Crit Care Med. 2010 Jun;38(6 Suppl):S169-74
pubmed: 20502171
Stat Sci. 2010 Feb 1;25(1):1-21
pubmed: 20871802
Intensive Care Med. 2017 Jun;43(6):730-749
pubmed: 28577069
Nephrol Dial Transplant. 2003 Jan;18(1):212-4
pubmed: 12480988
Paediatr Drugs. 2017 Feb;19(1):59-67
pubmed: 27943125
Crit Care Med. 2008 Apr;36(4 Suppl):S198-203
pubmed: 18382194
Shock. 2010 Aug;34(2):109-16
pubmed: 20634655
Cochrane Database Syst Rev. 2014 Jan 07;(1):CD003344
pubmed: 24395715
Crit Care Med. 2017 Jan;45(1):69-74
pubmed: 27618272
JAMA. 1993 Dec 22-29;270(24):2957-63
pubmed: 8254858
Br J Clin Pharmacol. 2017 Jun;83(6):1341-1349
pubmed: 28002877
Kidney Int. 2005 Jul;68(1):14-22
pubmed: 15954892
Antimicrob Agents Chemother. 2009 Jul;53(7):2887-91
pubmed: 19364846