Nephrotoxin‐Related Acute Kidney Injury and Predicting High‐Risk Medication Combinations in the Hospitalized Child

Abstract

BACKGROUND: In the hospitalized patient, nephrotoxin exposure is one potentially modifiable risk factor for acute kidney injury (AKI). Clinical decision support based on nephrotoxin ordering was developed at our hospital to assist inpatient providers with the prevention or mitigation of nephrotoxin-related AKI. The initial decision support algorithm (Algorithm 1) was modified in order to align with a national AKI collaborative (Algorithm 2). OBJECTIVE: Our first aim was to determine the impact of this alignment on the sensitivity and specificity of our nephrotoxin-related AKI detection system. Second, if the system efficacy was found to be suboptimal, we then sought to develop an improved model. DESIGN: A retrospective cohort study in hospitalized patients between December 1, 2013 and November 30, 2015 (N = 14,779) was conducted. INTERVENTIONS: With the goal of increasing nephrotoxin-related AKI detection sensitivity, a novel model based on the identification of combinations of high-risk medications was developed. RESULTS: Application of the algorithms to our nephrotoxin use and AKI data resulted in sensitivities of 46.9% (Algorithm 1) and 43.3% (Algorithm 2, P = .22) and specificities of 73.6% and 89.3%, respectively (P < .001). Our novel AKI detection model was able to deliver a sensitivity of 74% and a specificity of 70%. CONCLUSIONS: Modifications to our AKI detection system by adopting Algorithm 2, which included an expanded list of nephrotoxins and equally weighting each medication, did not improve our nephrotoxin-related AKI detection. It did improve our system’s specificity. Sensitivity increased by >50% when we applied a novel algorithm based on observed data with identification of key medication combinations.

Advances in pediatric acute kidney injury pharmacology and nutrition: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

“…Importantly for the smallest neonates, the Baby NINJA program did not increase the need for blood transfusions [ 38 ]. Further potential extensions include developing reflex serum creatinine monitoring for high-risk patients and local medication list tailoring [ 39 ].…”

Die Biomarker TIMP-2 und IGFBP7 in der Diagnostik der Niereninsuffizienz

“…Die Zellzyklus-Arrest-Proteine "tissue inhibitor of metalloprokinase 2" (TIMP-2) und "insulin-like growth factor binding protein 7" (IGFBP7) werden in den renalen Tubulizellen während zellulärer Stressphasen oder bei Verletzungen früh exprimiert [19,21,41,42,[49][50][51][52][53].…”