Quantifying the potential contribution of drugs to the occurrence of acute kidney injury in patients with chronic kidney disease
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background: We sought to comprehensively describe drug-related components associated with acute kidney injury (AKI) in patients with chronic kidney disease (CKD), describing the incidence of drug-related AKI, the proportion of preventable AKI, identified the various drugs potentially associated with it, explored the risk factors, and assessed the 1-year incidences of the recurrence of drug-related AKI, kidney failure, and death. Methods: CKD-REIN is a French national prospective cohort of 3033 nephrology outpatients with a confirmed diagnosis of CKD (eGFR <60 ml/min/1.73 m²). AKIs and adverse drug reactions (ADRs) were prospectively identified from hospital reports, medical records, and patient interviews. Expert nephrologists used the KDIGO criteria to adjudicate all stages of AKI, and expert pharmacologists used validated tools to adjudicate ADRs (including drug-related AKIs). Results: Over a median [interquartile range] period of 4.9 [3.4-5.1] years, 832 cases of AKI were reported in 639 (21%) of the 3033 study participants. The drug-related component associated with AKI accounted for 236 cases, and 28% were judged to be preventable or potentially preventable. The three most frequently implicated drug classes were diuretics, renin-angiotensin system inhibitors, and contrast agents. A history of cardiovascular events, diabetes, lower levels of hemoglobin and eGFR, poor medication adherence, and ≥5 drugs taken daily were associated with a greater risk of drug-related AKI. Full recovery was not attained in 64 (27%) of the 236 cases of drug-related AKI. The 1-year cumulative incidences of recurrence of drug-related AKI, kidney replacement therapy, and death were 7%, 15%, and 11%, respectively, after the first drug-related AKI. Conclusions: Drug-related AKI is prevalent among patients with CKD. Even though a substantial proportion of these events were classified as stage 1, our findings point to a poor prognosis.
Source: Clinical Kidney Journal
DOI: 10.1093/ckj/sfae357
Authors: Solène M Laville, Janice Vendar, Ziad A Massy, Valérie Gras-Champel, Julien Moragny, Luc Frimat, Maurice Laville, Christian Jacquelinet, Roberto Pecoits-Filho, Natalia Alencar De Pinho, Aghilès Hamroun, Sophie Liabeuf, Sophie Liabeuf, the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) Study Group, Natalia Alencar de Pinho, Christian Combe, Denis Fouque, Luc Frimat, Aghilès Hamroun, Christian Jacquelinet, Oriane Lambert, Céline Lange, Maurice Laville, Sophie Liabeuf, Sophie Liabeuf, Ziad A Massy, Marie Metzger, Christophe Pascal, Roberto Pecoits-Filho, Bénédicte Stengel, T Hannedouche, B Moulin, A Klein, C Combe, J P Bourdenx, A Keller, C Delclaux, B Vendrely, B Deroure, A Lacraz, T Lobbedez, I Landru, Z Massy, P Lang, X Belenfant, E Thervet, P Urena, M Delahousse, C Vela, M Essig, D Clément, H Sekhri, M Smati, M Jamali, B Hacq, V Panescu, M Bellou, Luc Frimat, N Kamar, C Noël, F Glowacki, N Maisonneuve, R Azar, M Hoffmann, M Hourmant, A Testa, D Besnier, G Choukroun, G Lambrey, S Burtey, G Lebrun, E Magnant, M Laville, D Fouque, L Juillard, C Chazot, P Zaoui, F Kuentz
Institutions: Centre Hospitalier Universitaire Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires, Université de Picardie Jules Verne, Inserm, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Assistance Publique – Hôpitaux de Paris, Centre de recherche en Epidémiologie et Santé des Populations, Hôpital Ambroise-Paré, Centre Hospitalier Régional et Universitaire de Nancy, Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes – Région Est, Université de Lorraine, Université de Lyon, Laboratoire de recherche en cardiovasculaire, métabolisme, diabétologie et nutrition, Agence de la Biomédecine, Arbor Research Collaborative for Health, Université de Lille, Institut Pasteur de Lille
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,322
Awards: G2795494276, G5945692617
OpenAlex ID: W4404506990