Nephrotoxin Stewardship

Kane‐Gill, Sandra L.

doi:10.1016/j.ccc.2020.11.002

Cited by 18 publications

(46 citation statements)

References 74 publications

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“…Sandra Kane-Gill hat in diesem Jahr erstmals, angelehnt an die bereits etablierten ABS-Programme, einen strukturierten Maßnahmenkatalog zum rationalen Umgang mit nephrotoxischen Medikamenten zusammengestellt 5 . Dabei verfolgt ein Nephrotoxin-Stewardship-Programm 3 Ziele:…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

“…Spiegelkontrollen sollten engmaschig erfolgen. Zudem sollte bei jeder neuen Verordnung der Wirkstoff hinsichtlich seiner Nephrotoxizität und möglicher Interaktionen mit anderen bereits verordneten Wirkstoffen beurteilt werden 5 .…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

“…Derzeit ist diese Hinweismeldung allerdings aufgrund fehlender IT-Schnittstellen oft nicht mit der GFR des Patienten verknüpft und/oder noch sehr fehleranfällig 6 . Ebenso wären automatisch erscheinende Empfehlungen zum Absetzen eines Medikaments oder Vorschläge für alternative Wirkstoffe sinnvoll 5 .…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

“…Darüber hinaus ist die Medikation auch nach einem ANV kritisch zu überprüfen, um weitere Episoden eines medikamenteninduzierten ANV und die Entstehung oder den Progress einer bereits bestehenden CKD zu verhindern. Dazu gehören insbesondere der rationale Einsatz von Statinen und ACE-/AT1-Inhibitoren sowie die Vermeidung von OTC-Medikamenten wie NSAID 5 .…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

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Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Boss¹,

Kribben²

2022

Dtsch Med Wochenschr

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Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

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Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Boss¹,

Kribben²

2022

Dtsch Med Wochenschr

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“…Healthcare professionals depend on primary, secondary, and tertiary information sources to enumerate potentially nephrotoxic drugs for practice and research. This is a tedious process and can be complex with the substantial discrepancy in nephrotoxins provided by various sources [ 9 , 10 ]. Further, rating the identified nephrotoxins based on their potential or likelihood of causing AKI is elusive given the lack of evidentiary support for such a comparison.…”

Section: Introductionmentioning

confidence: 99%

Consensus Obtained for the Nephrotoxic Potential of 167 Drugs in Adult Critically Ill Patients Using a Modified Delphi Method

et al. 2022

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Introduction The approach to evaluating nephrotoxins in studies of drug-associated acute kidney injury varies. Some studies use a list of under ten drugs for evaluation whereas others include over 100 drugs. Drugs are typically assigned a binary classification, nephrotoxic or not nephrotoxic. This oversimplifies the nephrotoxic potential of the drugs under investigation. Objective This study aimed to assign a nephrotoxin potential for 167 drugs used in the adult critical care setting. Methods A three-round, international, interdisciplinary, web-based modified-Delphi study was used to evaluate nephrotoxins used in adult critically ill patients. Twenty-four international experienced clinicians were identified through the Acute Disease Quality Initiative group and professional affiliations. Included individuals represented the fields of intensive care, nephrology, and pharmacy. One hundred and fifty-nine medications were identified from the literature, with eight additional medications added after the first round, for a total of 167 medications. The primary outcome was consensus achieved for nephrotoxicity ratings. Scores were evaluated each round to determine if a consensus was met. Results Our nephrotoxin potential index rating indicated that 20 drugs were nephrotoxicity probable or probable/definite per consensus. Nephrotoxic potential was assessed based on the standard use of medications in intensive care and the following consensus scores: 0 = no nephrotoxic potential, 1 = possible nephrotoxic potential, 2 = probable nephrotoxic potential, 3 = definite nephrotoxic potential. Conclusions The nephrotoxin potential index rating allows for prioritization of targeted drugs with greater nephrotoxic potential for institutional nephrotoxin stewardship programs. Furthermore, the nephrotoxin potential index rating provides homogeneity for research and guidance on detailed assessments by severity for each drug. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01173-4.

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Contemporary considerations for nephrotoxin stewardship: Estimating kidney function and use of novel biomarkers

Kane‐Gill,

Amatullah,

Tran

et al. 2024

J Am Coll Clin Pharm

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Drug‐associated acute kidney injury (D‐AKI) constitutes approximately 19%–26% of all acute kidney injury (AKI) cases in hospitalized patients. Notably, there is often a deficiency in optimal drug management after D‐AKI diagnosis, with only about half of the patients experiencing discontinuation of nephrotoxins and one‐fifth avoiding further nephrotoxin administration. Nephrotoxin stewardship involves the application of coordinated care management strategies to ensure the safe utilization of nephrotoxins and renally eliminated medications. The purpose of this paper is to review nephrotoxin stewardship strategies and highlight contemporary considerations for estimating kidney function and the use of novel biomarkers as part of the stewardship program. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) 2021 serum creatinine formula is now recommended for estimating kidney function for adults in most clinical situations in the United States. It is time to reevaluate how healthcare professionals think of estimating kidney function for drug dosing with the use of the non‐indexed, race‐free, CKDEPI 2021 equation. In addition, widespread use of serum cystatin C (CysC) is anticipated so estimated glomerular filtration rate equations that incorporate serum CysC will need to be further evaluated for drug dosing recommendations and how the use of serum CysC can complement serum creatinine‐based equations. Lastly, novel kidney stress/damage biomarkers should be viewed as a piece of a complex scenario of D‐AKI prediction, diagnosis, and prognosis and should be interpreted along with other diagnostic criteria in relation to the clinical condition of the patient. These contemporary considerations for drug dosing and D‐AKI management are important components of nephrotoxin stewardship.

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Nephrotoxin Stewardship

Cited by 18 publications

References 74 publications

Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Consensus Obtained for the Nephrotoxic Potential of 167 Drugs in Adult Critically Ill Patients Using a Modified Delphi Method

Contemporary considerations for nephrotoxin stewardship: Estimating kidney function and use of novel biomarkers

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