Drug-Induced Kidney Injury in the Elderly

Khan, Sana; Loi, Valentina; Rosner, Mitchell H.

doi:10.1007/s40266-017-0484-4

Cited by 54 publications

(67 citation statements)

References 139 publications

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“…Moreover, as reported previously [14][15][16][17][18][19][20][21], the incidence of AKI was higher in the elderly patients. Possible explanations for this include depleted nephron reserves, increased susceptibility to exposure to nephrotoxic agents, impaired ability to repair injuries, polypharmacy, and multiple comorbidities, specifically CKD [5,22,23]. Furthermore, elderly individuals are susceptible to severe infection and are therefore more likely to develop septic acute tubular necrosis (ATN) and experience mortality [3].…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

Pongsittisak

Phonsawang

Jaturapisanukul

et al. 2020

Critical Care Research and Practice

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Background. Aging is associated with a high risk of acute kidney injury (AKI), and the elderly with AKI show a higher mortality rate than those without AKI. In this study, we compared AKI outcomes between elderly and nonelderly patients in a university hospital in a developing country. Materials and Methods. This retrospective cohort study included patients with AKI who were admitted to the medical intensive care unit (ICU) between January 1, 2012, and December 31, 2017. The patients were divided into the elderly (eAKI; age ≥65 years; n = 158) and nonelderly (nAKI; n = 142) groups. Baseline characteristics, comorbidities, principle diagnosis, renal replacement therapy (RRT) requirement, hospital course, and in-hospital mortality were recorded. The primary outcome was in-hospital mortality. Results. The eAKI group included more females, patients with higher Acute Physiology and Chronic Health Evaluation II scores, and patients with more comorbidities than the nAKI group. The etiology and staging of AKI were similar between the two groups. There were no significant differences in in-hospital mortality (p=0.338) and RRT requirement (p=0.802) between the two groups. After adjusting for covariates, the 28-day mortality rate was similar between the two groups (p=0.654), but the 28-day RRT requirement was higher in the eAKI group than in the nAKI group (p=0.042). Conclusion. Elderly and nonelderly ICU patients showed similar survival outcomes of AKI, although the elderly were at a higher risk of requiring RRT.

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Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

Pongsittisak

Phonsawang

Jaturapisanukul

et al. 2020

Critical Care Research and Practice

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“…Treatment is aimed at the underlying cause in an effort to prevent further kidney damage and progression of the disease process. Unfortunately, the geriatric population is at an increased risk of kidney damage due to the use of numerous medications and the aging kidney [5]. In addition, the normal aging process is associated with renal structural and functional changes.…”

Section: Effects Of Nephrotoxic Medicationsmentioning

confidence: 99%

“…In addition, the normal aging process is associated with renal structural and functional changes. These changes in the kidneys in combination with co-morbidities, places the aging population at high risk for developing acute kidney injury and later development of chronic kidney disease [5].…”

Section: Effects Of Nephrotoxic Medicationsmentioning

confidence: 99%

Long Term Effects of Nephrotoxic Medications and the Increased Prevalence of Kidney Disease in the Geriatric Population

2020

TAPI

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The use of nephrotoxic medications is an ongoing challenge within the health care profession. Many over-the-counter (OTC) medications used to treat numerous disease processes are becoming a major concern to the health care community as it relates to continued use and damaging kidneys in vulnerable populations. The geriatric population in particular, is one that is associated with many challenges due to the normal aging process, co-morbidities, the use of multiple medications, the misuse of OTC medications and drug-to-drug interactions. This paper will discuss three common OTC medications that are associated with nephrotoxicity. These medications include aspirin, nonsteroidal anti-inflammatory medications, and herbal medications. The research articles reviewed will explore the relationship of long term effects of the use of nephrotoxic medications and the prevalence of kidney disease in the geriatric population.

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“… 4 Among the elderly patients, drug-induced nephrotoxicity contributed to up to 66% of hospitals developed AKI. 5 …”

Section: Introductionmentioning

confidence: 99%

<p>Effect of Kaempferol on Tacrolimus-Induced Nephrotoxicity and Calcineurin B1 Expression Level in Animal Model</p>

Ali¹,

Almalki²,

Alharthy³

2020

JEP

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Background The kidneys are considered one of the most susceptible organs for adverse drug effects, particularly in post-transplant conditions. Tacrolimus (FK506), a calcineurin inhibitor immunosuppressant, is an essential component in the transplantation regimen. Despite that, nephrotoxicity is a severe drawback for its chronic utilization, where oxidative stress might be implicated. Kaempferol (KMF) is a natural flavonoid that has many adaptable biological activities, including antioxidant action. Objective Exploring the KMF protective effect on FK506-induced nephrotoxicity and the underlying role of calcineurin B1. Methods Twenty-four male albino-Wistar rats were randomly divided into three equal groups. The control group received solvents: propylene glycol, i.p. and 0.5% carboxymethyl cellulose, PO; FK506 group was injected with FK506 (0.6 mg/kg, i.p.), and FK506+KMF group was given FK506 (0.6 mg/kg, i.p.) and KMF (10 mg/kg, PO). The treatment regimen for all groups was once daily for 30 days. ELISA technique applied for measuring FK506 trough level and nephrotoxicity biomarkers in serum (cystatin C and urea) on days 15 and 30, and in kidney tissue homogenate (MDA and calcineurin B1) on day 30. Results In FK506-treated rats, the FK506 trough level was 7.84 ± 1.31 ug/l on day 15 and 9.54 ± 1.45 ug/l on day 30. FK506 use has significantly ( P <0.01) increased biomarkers levels of cystatin C (325% and 477%), urea (177% and 245%), MDA (1253%), except calcineurin B1 that has decreased (97%). The KMF combination has resulted in a significant reduction in the FK506 trough level by day 30 (6.79 ± 1.35 ug/l, P <0.01). KMF has significantly ameliorated the levels of cystatin C (46% and 73%, P <0.001), urea (38% and 68%, P< 0.001), MDA (75%, P <0.001), and calcineurin B1 (1833%, P <0.05). Conclusion Oxidative stress and calcineurin B1 are contributing factors in FK506-induced nephrotoxicity. Hence, inhibition of calcineurin enzyme is not limited to the immune cells. KMF could be a novel nephroprotective antioxidant.

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Drug-Induced Kidney Injury in the Elderly

Cited by 54 publications

References 139 publications

Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

Long Term Effects of Nephrotoxic Medications and the Increased Prevalence of Kidney Disease in the Geriatric Population

<p>Effect of Kaempferol on Tacrolimus-Induced Nephrotoxicity and Calcineurin B1 Expression Level in Animal Model</p>

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