How to manage the dose of drugs in cancer patients with acute kidney injury, practical recommendations

Janus, Nicolas; Desplanques, Pierre-Yves

doi:10.1007/s11096-023-01656-z

Cited by 1 publication

(1 citation statement)

References 23 publications

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“…The management of drug therapy in patients developing AKI remains a topic of debate. Some authors advocate for considering an alternative drug with no dose adjustment requirements in CKD as a first choice [ 28 ]. While this option may not always be feasible due to the limited availability of alternative non-renally excreted drugs, it is also not necessarily the most efficient solution as it unnecessarily restricts the therapeutic portfolio.…”

Section: Discussionmentioning

confidence: 99%

Effects of inpatient creatinine testing frequency on acute kidney injury identification and staging: a historical cohort study

Oliveira,

Duarte-Ramos,

Alves da Costa

et al. 2024

Int J Clin Pharm

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Background Acute kidney injury (AKI) is a multifactorial condition often induced by drugs commonly used in hospitals. Identifying and staging AKI necessitates frequent monitoring of renal function. Aim To assess the impact of real-world hospital practices regarding serum creatinine (SCr) testing on the identification and staging of AKI, and its implications for adjusting drug doses. Method A historical cohort study utilizing hospital records from all adult patients admitted between 01/06/2018 and 31/12/2020 was conducted. Patients with no SCr assessment during their stay or those with an SCr at admission ≥ 2 mg/dL were excluded. AKI was determined using two criteria, namely AKIN and KDIGO, considering the time intervals between two SCr tests as outlined in the criteria. Additionally, patients with SCr increases exceeding AKI limits, regardless the time interval, were also identified. The estimated glomerular filtration rate (eGFR) and kinetic eGFR (KeGFR) were calculated. Results During the study period, 17,269 hospitalizations and 62,255 SCr tests were recorded. Among the 17,032 hospitalizations with a length of stay > 48 h, 46.8% experienced periods with no SCr tests performed for more than 48 h. Any stage of AKI was identified in 7.0% of patients and in 9.1% using AKI and KDIGO criteria, respectively. Ignoring time limits in both criteria revealed potential AKI in 1942 patients (11.2%), indicating a potential underdiagnosis of AKI by 37.5% or 19.1%, depending on the criteria used. A total of 76 drugs requiring dose adjustment in patients with eGFR ≤ 50 ml/min were prescribed in 78.5% admissions. These drugs were prescribed in 87.9% of patients potentially underdiagnosed with AKIN and in 88.9% with KDIGO. Conclusion There is a need for changes in the established hospital procedures to ensure more frequent testing of SCr levels. Implementing an advanced scope of practice for clinical pharmacists could support these changes.

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Section: Discussionmentioning

confidence: 99%