Drug Class Combination–Associated Acute Kidney Injury

Rivosecchi, Ryan; Kellum, John A.; Dasta, Joseph F.; Armahizer, Michael; Bolesta, Scott; Buckley, Mitchell S.; Dzierba, Amy; Frazee, Erin; Johnson, Heather; Kim, Catherine; Murugan, Raghavan; Smithburger, Pamela L.; Wong, Adrian; Gill, Sandra L.

doi:10.1177/1060028016657839

Cited by 34 publications

(19 citation statements)

References 109 publications

(124 reference statements)

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“…Antibiotics were present also in a minority of our patients and this low number precluded us to infer their responsibility in CA-AKI. Regarding diuretics, there are surprisingly few studies which focus on their role in inducing AKI, especially when they are combined with renin-angiotensin system (RAS) blockers [ 15 ]. Fifty-two percent of our patients with AKI had diuretics and they were associated (mainly in fixed dose combinations) with RAS blockers in one quarter of the patients with CA-AKI.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for community-acquired acute kidney injury in patients with and without chronic kidney injury and impact of its initial management on prognosis: a prospective observational study

et al. 2017

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BackgroundWe aimed to describe clinical characteristics of patients with community-acquired acute kidney injury (CA-AKI), the effectiveness of initial management of CA-AKI, its prognosis and the impact of medication on its occurrence in patients with previous chronic kidney injury (CKI).MethodsWe undertook a prospective observational study within the Emergency Department (ED) of a University Hospital, screening for any patient >16 years admitted with an eGFR <60 ml/mn/1.73 m2 and a rise in serum creatinine as compared to previous values. Patients’ medical files were reviewed by a panel of nephrologists in the subsequent days and at one and three-years follow-up.ResultsFrom May 1st to June 21st 2013, there were 8464 admissions in the ED, of which 653 had an eGFR <60 ml/mn/1.73 m2. Of these, 352 had previous CKI, 341 had CA-AKI, and 104 had CA-ACKI (community-acquired acute on chronic kidney injury). Occurrence of superimposed CA-AKI in CKI patients was associated with male gender and with use of diuretics, but not with use of ARBs or ACEIs.Adequate management of CA-AKI defined as identification, diagnostic procedures and therapeutic intervention within 24 h, was recorded in 45% of the cases and was not associated with improved outcomes.Three-year mortality was 21 and 48% in CKI and CA-ACKI patients respectively, and 40% in patients with only CA-AKI (p < 0.001). Mortality was significantly associated with age, hypertension, ischemic heart disease and CA-AKI.Progression of renal insufficiency was associated with male gender and age.ConclusionsCA-AKI is more frequently encountered in male patients and those treated with diuretics and is an independent risk factor for long-term mortality. Its initial adequate management failed to improve outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0792-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Risk factors for community-acquired acute kidney injury in patients with and without chronic kidney injury and impact of its initial management on prognosis: a prospective observational study

et al. 2017

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“…Therefore, the higher intratubular levels of uric acid may produce crystal deposition, inflammation and oxidative stress [69]. SGLT2 inhibition is also associated with shift of oxygenation from medulla to cortex; this effect may predispose DM2 patients to AKI when they are exposed to additional injuries, such as contrast media, NSAIDs, volume depletion [70,71,72]. Hence, an accurate evaluation of volemic status and screening of potential kidney toxins should be a preliminary step in patients undergoing SGLT2-i therapy.…”

Section: Adverse Effects Of Sglt2 Inhibitorsmentioning

confidence: 99%

SGLT2 Inhibitors: Nephroprotective Efficacy and Side Effects

et al. 2019

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The burden of diabetic kidney disease (DKD) has increased worldwide in the last two decades. Besides the growth of diabetic population, the main contributors to this phenomenon are the absence of novel nephroprotective drugs and the limited efficacy of those currently available, that is, the inhibitors of renin-angiotensin system. Nephroprotection in DKD therefore remains a major unmet need. Three recent trials testing effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2-i) have produced great expectations on this therapy by consistently evidencing positive effects on hyperglycemia control, and more importantly, on the cardiovascular outcome of type 2 diabetes mellitus. Notably, these trials also disclosed nephroprotective effects when renal outcomes (glomerular filtration rate and albuminuria) were analyzed as secondary endpoints. On the other hand, the use of SGLT2-i can be potentially associated with some adverse effects. However, the balance between positive and negative effects is in favor of the former. The recent results of Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation Study and of other trials specifically testing these drugs in the population with chronic kidney disease, either diabetic or non-diabetic, do contribute to further improving our knowledge of these antihyperglycemic drugs. Here, we review the current state of the art of SGLT2-i by addressing all aspects of therapy, from the pathophysiological basis to clinical effectiveness.

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“…Our study found that the combinations of codeine phosphate with metoclopramide, zopiclone, prednisone and the medication combination amoxicillin and clavulanic acid increase the risk of AKI. A systematic review concluded a lack of well‐designed studies addressing medication class combination associated with AKI . The systematic review found that there is only evidence to support the combination of NSAIDs and diuretics with or without additional renin‐angiotensin aldosterone agents, contributing to AKI, but the evidence to support other medication combinations with AKI is inadequate.…”

Section: Discussionmentioning

confidence: 99%

“…AKI in older adults is associated with an increased risk of mortality, lower health‐related quality of life, and increased length of hospital stay . A systematic review of the literature concluded that the quality of evidence of medication combinations and their association with the development of AKI is weak . In addition, there is limited population‐level evidence available on the medication combinations associated with AKI.…”

Section: Introductionmentioning

confidence: 99%

Identifying drug combinations associated with acute kidney injury using association rules method

Nishtala

Chyou

2020

Pharmacoepidemiology and Drug

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Background: Older adults are at an increased risk of acute kidney injury (AKI) because of aging, multiple comorbidities, and polypharmacy.Objectives: The aim of this case-crossover study was to apply association rule (AR) analysis to ascertain drug combinations contributing to the risk of AKI in adults aged 65 years and older. Methods:We sourced a nationwide representative sample of New Zealanders aged ≥65 years from the pharmaceutical collections and hospital discharge information.Prescription records (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) of drugs of interest were sourced from New Zealand pharmaceutical collections (Pharms). We classified medication exposure, as a binary variable, at individual drug level belonging to medication classes including antimicrobials, antihistamines, diuretics, opioids, nonsteroidal antiinflammatory medications. Several studies have associated the drugs of interest from these medication classes with AKI in older adults. We extracted the first-time coded diagnosis of AKI from the National Minimal Data Set. A unique patient identifier linked the prescription data set to the event data set, to set up a case-crossover cohort, indexed at the first AKI event. ARs were then applied to identify frequent drug combinations in the case and the control periods (l-day observation with a 35-day washout period), and the association of AKI with each frequent drug combination was tested by computing a matched odds ratio (MOR) and its 95% confidence interval (CI). Results:We identified 55 747 individuals (mean age 82.14) from 2005 to 2014 with incident AKI and exposed to at least one of the drugs of interest. ARs identified several medication classes including antimicrobials, nonsteroidal anti-inflammatory drugs, and opioids are associated with AKI. The frequently used medicines associated with AKI are trimethoprim (MOR = 1.68; 95% CI = [1.54-1.80]), ondansetron (MOR = 1.43; 95% CI = [1.25-1.64]), codeine phosphate plus metoclopramide (MOR = 1.37; 95% CI = [1.11-1.63]), and norfloxacin (MOR = 1.24; 95% CI [1.05-1.42]). Conclusions:We applied ARs, a novel methodology, to big data to ascertain drug combinations associated with AKI. ARs uncovered previously implicated medication classes that increase the risk of AKI in older adults. The finding that ondansetron increases the risk of AKI requires further investigation. acute kidney injury, association rules, case-crossover design, older people, pharmacoepidemiology, pharmacovigilance

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Drug Class Combination–Associated Acute Kidney Injury

Cited by 34 publications

References 109 publications

Risk factors for community-acquired acute kidney injury in patients with and without chronic kidney injury and impact of its initial management on prognosis: a prospective observational study

Risk factors for community-acquired acute kidney injury in patients with and without chronic kidney injury and impact of its initial management on prognosis: a prospective observational study

SGLT2 Inhibitors: Nephroprotective Efficacy and Side Effects

Identifying drug combinations associated with acute kidney injury using association rules method

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