Chen Liu1, Suying Yan1, Yuqin Wang1, Jinwei Wang2, Xiujuan Fu3, Hongtao Song4, Rongsheng Tong5, Mei Dong6, Weihong Ge7, Jiawei Wang8, Hui Yang9, Changlian Wang10, Peiyuan Xia11, Limei Zhao12, Sijing Shen13, Juan Xie14, Yangui Xu15, Peizhi Ma16, Hongjian Li17, Shegui Lu18, Yufeng Ding19, Ling Jiang20, Yang Lin21, Maoyi Wang22, Feng Qiu23, Wanyu Feng24, Li Yang2. 1. Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China. 2. Renal Division, Peking University First Hospital, Peking University, Beijing, China. 3. Department of Pharmacy, The Second Hospital of Jilin University, Changchun, China. 4. Department of Pharmacy, 900 Hospital of the Joint Logistic Team, Fuzhou, China. 5. Department of Pharmacy, Sichuan Provincial People's Hospital, Chengdu, China. 6. Department of Pharmacy, Affiliated Tumor Hospital Harbin Medical University, Harbin, China. 7. Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, China. 8. Department of Pharmacy, Beijing Tongren Hospital, Beijing, China. 9. Department of Pharmacy, Qinghai University Affiliated Hospital, Xining, China. 10. Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China. 11. Department of Pharmacy, The First Hospital Affiliated to Army Medical University, Chongqing, China. 12. Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China. 13. Department of Pharmacy, Peking University Shougang Hospital, Beijing, China. 14. Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China. 15. Department of Pharmacy, Tianjin First Center Hospital, Tianjin, China. 16. Department of Pharmacy, Henan Provincial Peoples' Hospital, Zhengzhou, China. 17. Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, Jinan, China. 18. Department of Pharmacy, The Second Hospital of Nanchang University, Nanchang, China. 19. Department of Pharmacy, The Tongji Affiliated Hospital of Tongji Medical College, Huazhong University of science, Wuhan, China. 20. Department of Pharmacy, Anhui Provincial Hospital, Hefei, China. 21. Department of Pharmacy, Beijing Anzhen Hospital, Beijing, China. 22. Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 23. Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 24. Department of Pharmacy, Peking University People's Hospital, Beijing, China.
Abstract
INTRODUCTION: Drug-induced acute kidney injury (D-AKI) is one of the important types of AKI. The incidence of D-AKI in China has rarely been studied. OBJECTIVE: This study aims to explore the disease burden, related drugs, and risk factors of D-AKI. METHODS: A nationwide cross-sectional survey was conducted in adult patients from 23 academic hospitals in 17 provinces in China. Suspected AKI was screened based on serum creatinine changes in accordance with the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for AKI, patients who met the diagnosis of hospital-acquired AKI in January and July of 2014 were defined. Suspected AKI was firstly evaluated for the possibility of D-AKI by pharmacists using the Naranjo Scale and finally defined as D-AKI by nephrologists through reviewing AKI clinical features. RESULTS: Altogether 280,255 hospitalized patients were screened and 1,960 cases were diagnosed as hospital-acquired AKI, among which 735 cases were defined as having D-AKI (37.50%, 735/1,960) with an in-hospital mortality rate of 13.88% and 54.34% of the survivors did not achieve full renal recovery. 1,642 drugs were related to AKI in these patients. Anti-infectives, diuretics, and proton pump inhibitors were the top 3 types of drugs relevant to D-AKI, accounting for 66.63% cumulatively. Besides age, AKI staging, severe disease, hypoalbuminemia, plasma substitute, and carbapenem related D-AKI were independent risk factors for in-hospital mortality of D-AKI patients. CONCLUSION: In China, D-AKI has caused a substantial medical burden. Efforts should be made to pursue nephrotoxic drug stewardship to minimize attributable risk and improve the prevention, diagnosis, and treatment of D-AKI.
INTRODUCTION: Drug-induced acute kidney injury (D-AKI) is one of the important types of AKI. The incidence of D-AKI in China has rarely been studied. OBJECTIVE: This study aims to explore the disease burden, related drugs, and risk factors of D-AKI. METHODS: A nationwide cross-sectional survey was conducted in adult patients from 23 academic hospitals in 17 provinces in China. Suspected AKI was screened based on serum creatinine changes in accordance with the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for AKI, patients who met the diagnosis of hospital-acquired AKI in January and July of 2014 were defined. Suspected AKI was firstly evaluated for the possibility of D-AKI by pharmacists using the Naranjo Scale and finally defined as D-AKI by nephrologists through reviewing AKI clinical features. RESULTS: Altogether 280,255 hospitalized patients were screened and 1,960 cases were diagnosed as hospital-acquired AKI, among which 735 cases were defined as having D-AKI (37.50%, 735/1,960) with an in-hospital mortality rate of 13.88% and 54.34% of the survivors did not achieve full renal recovery. 1,642 drugs were related to AKI in these patients. Anti-infectives, diuretics, and proton pump inhibitors were the top 3 types of drugs relevant to D-AKI, accounting for 66.63% cumulatively. Besides age, AKI staging, severe disease, hypoalbuminemia, plasma substitute, and carbapenem related D-AKI were independent risk factors for in-hospital mortality of D-AKI patients. CONCLUSION: In China, D-AKI has caused a substantial medical burden. Efforts should be made to pursue nephrotoxic drug stewardship to minimize attributable risk and improve the prevention, diagnosis, and treatment of D-AKI.
Authors: Angela K Muriithi; Nelson Leung; Anthony M Valeri; Lynn D Cornell; Sanjeev Sethi; Mary E Fidler; Samih H Nasr Journal: Kidney Int Date: 2014-09-03 Impact factor: 10.612
Authors: C A Naranjo; U Busto; E M Sellers; P Sandor; I Ruiz; E A Roberts; E Janecek; C Domecq; D J Greenblatt Journal: Clin Pharmacol Ther Date: 1981-08 Impact factor: 6.875