&lt;p&gt;Community-Acquired Acute Kidney Injury Induced By Drugs In Older Patients: A Multifactorial Event&lt;/p&gt;

Robert, Laurine; Ficheur, Grégoire; Gautier, Sophie; Servais, Alexandre; Luyckx, M.; Soula, Julien; Décaudin, Bertrand; Guilhot, François; Puisieux, François; Chazard, Emmanuel; Beuscart, Jean‐Baptiste

doi:10.2147/cia.s217567

Cited by 15 publications

(19 citation statements)

References 40 publications

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“…Immunosuppressive drugs may induce acute tubular necrosis, chronic interstitial nephritis, and thrombotic microangiopathy [15]. Drug-induced AKIs are often avoidable [8,35]. Given that different types of medication are involved in CA-AKI and HA-AKI, it might be possible to adjust and improve the management of these injuries as a function of the affected population.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for and characteristics of community‐ and hospital‐acquired drug‐induced acute kidney injuries

Rey

Gras‐Champel

Choukroun

et al. 2022

Fundamemntal Clinical Pharma

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Drugs constitute one of the leading causes of acute kidney injuries (AKIs) and can appear in community (CA-AKI) or hospital (HA-AKI) population. The objectives of the present study of a cohort of hospitalized patients with AKI were to describe the characteristics of drug-induced AKIs and the patients' short-term outcomes and assess risk factors for drug-induced AKIs overall, CA-AKIs, and HA-AKIs. Based on a cohort of 1557 hospitalized patients suffering from AKIs based on PMSI extraction and chart review (IRA-PMSI), drug-induced AKIs were identified by applying the Naranjo adverse drug reaction (ADR) probability scale. Multivariate logistic regression was used to identify factors associated with CA-AKIs and/or HA-AKIs. When considering the 1557 patients who experienced an AKI, 445 (28.6%) of the injuries were drug-induced (180 CA-AKIs (40.4%) and 265 HA-AKIs (59.6%)). Antibiotics, diuretics, and contrast agents were significantly more likely to be involved in HA-AKIs, whereas antineoplastic, lipid-lowering drugs, antidiabetics, and immunosuppressive were significantly more likely to be involved in CA-AKIs. Female sex (odds ratio [OR] [95%CI] = 1.3 [1.04-1.67]), chronic kidney disease (CKD) (OR = 1.8 [1.40-2.67]), and a history of ADRs of any type (OR = 1.3 [1.05-1.73]) were significant risk factors for drug-induced AKIs. CKD was a risk factor for both CA-AKI and HA-AKI. In view of the long-term impact of AKI on the kidneys and the differences between our CA-AKI and HA-AKI subgroups, our present results are interesting for optimizing treatments, limiting the occurrence of CAand HA-AKIs and (ultimately) reducing healthcare costs. K E Y W O R D S acute kidney injury, community-and hospital-acquired, drug-induced, pharmacovigilance, PMSI, risk factors 1 | INTRODUCTION Acute kidney injury (AKI) is a common, treatable, reversible syndrome that can be immediately life-threatening and can have serious long-term consequences [1]. The main impact is on the kidney itself: the development of chronic kidney disease (CKD), accelerated progression to end-stage renal disease (ESRD), and failure to recover kidney function [2, 3]. The risk factors for AKI have been well studied; they include older age, female

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Section: Discussionmentioning

confidence: 99%

“…Drug-induced AKIs accounted for 28.6% of the AKIs [7]. Indeed, the main avoidable risk factor is the use of certain medications [8,9].…”

mentioning

confidence: 99%

Risk factors for and characteristics of community‐ and hospital‐acquired drug‐induced acute kidney injuries

Rey

Gras‐Champel

Choukroun

et al. 2022

Fundamemntal Clinical Pharma

View full text Add to dashboard Cite

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“…Common reasons for medication errors and preventable ADEs summarized from the kidney disease literature were lack of adaptation of drug therapy during intercurrent illness, 17 not following prescribing guidelines, 18 lack of knowledge of specific drugs and drug combinations causing patient harm, 19 lack of early AKI detection, 4 lack of monitoring, and lack of clinical decision support. 20 Systematic reviews emphasized the need for factors related to the patient, medication, and the related interactions to be taken into account for effective prevention.…”

Section: Resultsmentioning

confidence: 99%

Development of a Theory-Informed Behavior Change Intervention to Reduce Inappropriate Prescribing of Nephrotoxins and Renally Eliminated Drugs

2021

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Background: Goals of managing patients with acute kidney injury (AKI) are mitigating disease progression and ensuring safety while providing supportive care because no effective treatment exists. One strategy recommended in guidelines to meet these goals is optimizing medication management. Unfortunately, guideline implementation appears to be lacking as observed by the frequent occurrence of medication errors and adverse drug events. Objective: To address this performance gap in the care of hospitalized patients receiving nephrotoxins and renally eliminated drugs, we sought to provide a potential intervention based on theory-informed behavior change. Methods: Formative research with a qualitative analysis identifying what needs to change in patient care was completed by obtaining clinician opinion and expert opinion and reviewing the published literature. Frontline providers, including 8 physicians, 4 pharmacists, and a multiprofessional group of authors, provided insight into possible barriers to appropriate prescribing. Capability, Opportunity, Motivation and Behavior model and Theoretical Domain Framework were applied to characterize behavior change interventions and inform a potential implementation intervention for changing inappropriate prescribing behaviors. Results: Lack of knowledge about appropriate drug management in patients at risk for adverse outcomes was provided as a major barrier. Other reported barriers included a lack of: (1) tools to assist with drug management, (2) motivation to make changes, (3) routinization, and (4) an accountable clinician. Conclusions and Relevance: Assigning a designated clinician to execute a stepwise, routine care process following the checklist provided is a recommended intervention to overcome barriers. The intended impact is behavior change that reduces inappropriate prescribing.

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“…Reperfusion leads to the production of metabolites, such as nitric oxide and ROS, which can damage the cell membranes and lead to cell apoptosis. However, druginduced AKI is more common in infants and older people with underlying cardiovascular diseases and renal dysfunction, such as intravascular volume depletion, diabetes, congestive heart failure, chronic kidney disease, and sepsis (18,19). Druginduced renal injury, which results from the direct damage to the renal tubular epithelial cells, occurs when the increasing concentration of nephrotoxic drugs in the renal tubule reaches a toxic level.…”

Section: Different Immune Mechanisms Of Drug-induced and Ir-induced Akimentioning

confidence: 99%

Immunomodulatory Effects of Mesenchymal Stem Cells on Drug-Induced Acute Kidney Injury

et al. 2021

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Drug-induced nephrotoxicity is an important and increasing cause of acute kidney injury (AKI), which accounts for approximately 20% of hospitalized patients. Previous reviews studies on immunity and AKI focused mainly on ischemia-reperfusion (IR), whereas no systematic review addressing drug-induced AKI and its related immune mechanisms is available. Recent studies have provided a deeper understanding on the mechanisms of drug-induced AKI, among which acute tubular interstitial injury induced by the breakdown of innate immunity was reported to play an important role. Emerging research on mesenchymal stem cell (MSC) therapy has revealed its potential as treatment for drug-induced AKI. MSCs can inhibit kidney damage by regulating the innate immune balance, promoting kidney repair, and preventing kidney fibrosis. However, it is important to note that there are various sources of MSCs, which impacts on the immunomodulatory ability of the cells. This review aims to address the immune pathogenesis of drug-induced AKI versus that of IR-induced AKI, and to explore the immunomodulatory effects and therapeutic potential of MSCs for drug-induced AKI.

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<p>Community-Acquired Acute Kidney Injury Induced By Drugs In Older Patients: A Multifactorial Event</p>

Cited by 15 publications

References 40 publications

Risk factors for and characteristics of community‐ and hospital‐acquired drug‐induced acute kidney injuries

Risk factors for and characteristics of community‐ and hospital‐acquired drug‐induced acute kidney injuries

Development of a Theory-Informed Behavior Change Intervention to Reduce Inappropriate Prescribing of Nephrotoxins and Renally Eliminated Drugs

Immunomodulatory Effects of Mesenchymal Stem Cells on Drug-Induced Acute Kidney Injury

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