Clinical Characteristics and Outcomes of Drug-Induced Acute Kidney Injury Cases

被引：15

作者：

Yousif, Zaid K. ^{[1
]}

Koola, Jejo D. ^{[2
,3
]}

Macedo, Etienne ^{[4
]}

Cerda, Jorge ^{[5
,6
]}

Goldstein, Stuart L. ^{[7
,8
]}

Chakravarthi, Rajasekara ^{[9
]}

Lewington, Andrew ^{[10
]}

Selewski, David ^{[11
]}

Zappitelli, Michael ^{[12
]}

Cruz, Dinna ^{[4
]}

Tolwani, Ashita ^{[13
]}

Joy, Melanie S. ^{[14
,15
]}

Jha, Vivekanand ^{[16
,17
,18
]}

Ramachandran, Raja ^{[19
]}

Ostermann, Marlies ^{[20
]}

Pandya, Bhavna ^{[21
]}

Acharya, Anjali ^{[22
]}

Brophy, Patrick ^{[23
]}

Ponce, Daniela ^{[24
]}

Steinke, Julia ^{[25
]}

Bouchard, Josee ^{[26
]}

Irarrazabal, Carlos E. ^{[27
]}

Irarrazabal, Romina ^{[28
]}

Boltansky, Andres ^{[28
]}

Askenazi, David ^{[29
]}

Kolhe, Nitin ^{[30
]}

Claure-Del Granado, Rolando ^{[31
,32
]}

Benador, Nadine ^{[33
,34
]}

Castledine, Clare ^{[35
]}

Davenport, Andrew ^{[36
]}

Barratt, Jonathan ^{[37
]}

Bhandari, Sunil ^{[38
]}

Riley, Alyssa A. ^{[39
]}

Davis, T. K. ^{[40
]}

Farmer, Christopher ^{[41
]}

Hogarth, Michael ^{[2
]}

Thomas, Mark ^{[42
]}

Murray, Patrick T. ^{[43
]}

Robinson-Cohen, Cassianne ^{[44
]}

Nicoletti, Paola ^{[45
]}

Vaingankar, Sucheta ^{[46
]}

Mehta, Ravindra ^{[4
]}

Awdishu, Linda ^{[1
]}

机构：

[1] Univ Calif San Diego, Skaggs Sch Pharm & Pharmaceut, Div Clin Pharm, La Jolla, CA USA

[2] Univ Calif San Diego, Dept Med, Div Biomed Informat, La Jolla, CA USA

[3] Univ Calif San Diego, Dept Med, Div Hosp Med, La Jolla, CA USA

[4] Univ Calif San Diego, Dept Med, Div Nephrol, La Jolla, CA USA

[5] Albany Med Coll, Albany, NY USA

[6] St Peters Hosp Partners, Albany, NY USA

[7] Cincinnati Childrens Hosp, Ctr Acute Care Nephrol, Cincinnati, OH USA

[8] Univ Cincinnati, Coll Med, Cincinnati, OH USA

[9] STAR Hosp, Renown Clin Serv, Nephrol Serv, Hyderabad, Telangana, India

[10] St James Univ Hosp, Leeds, W Yorkshire, England

[11] Med Univ South Carolina, Dept Pediat, Charleston, SC USA

[12] Univ Toronto, Hosp Sick Children, Div Nephrol, Dept Pediat, Toronto, ON, Canada

[13] Univ Alabama Birmingham, Birmingham, AL USA

[14] Univ Colorado, Sch Pharm & Pharmaceut Sci, Aurora, CO USA

[15] Sch Med, Aurora, CO USA

[16] UNSW, George Inst Global Hlth, New Delhi, India

[17] Imperial Coll, Sch Publ Hlth, London, England

[18] MManipal Acad Higher Educ, Prasanna Sch Publ Hlth, Manipal, India

[19] Postgrad Inst Med Educ & Res, Chandigarh, India

[20] Kings Coll London, Guys & St Thomas Hosp, Dept Crit Care & Nephrol, London, England

[21] Aintree Univ Hosp NHS Fdn Trust, Liverpool Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England

[22] Albert Einstein Coll Med, Jacobi Med Ctr, Bronx, NY USA

[23] Univ Rochester, Sch Med & Dent, Dept Pediat, New York, NY USA

[24] Univ Sao Paulo State, Sao Paulo, Brazil

[25] Helen DeVos Childrens Hosp, Grand Rapids, MI USA

[26] Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[27] Univ Los Andes, Ctr Invest & Innovac Biomed, Programa Fisiol, Santiago, Chile

[28] Clin Davila, Santiago, Chile

[29] Childrens Alabama UAB Pediat, Birmingham, AL USA

[30] Royal Derby Hosp, Derby, England

[31] Hosp Obrero 2 CNS Cochabamba, Div Nephrol, Cochabamba, Bolivia

[32] Univ Mayor San Simon, Sch Med Cochabamba, Cochabamba, Bolivia

[33] Univ Calif San Diego, San Diego, CA USA

[34] Rady Childrens Hosp, San Diego, CA USA

[35] Brighton & Sussex Med Sch, Brighton, E Sussex, England

[36] UCL, Royal Free London NHS Trust London, Dept Renal Med, London, England

[37] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England

[38] Hull Univ Teaching Hosp NHS Trust, Kingston Upon Hull, Yorks, England

[39] Baylor Coll Med, Dept Pediat, Nephrol Sect, Houston, TX USA

[40] St Louis Childrens Hosp, St Louis, MO USA

[41] Univ Kent, Ctr Hlth Serv Studies, George Allen Wing,Cornwallis Bldg, Canterbury, Kent, England

[42] Birmingham Heartlands Hosp, Birmingham, AL USA

[43] Univ Coll Dublin, Sch Med, Dublin, Ireland

[44] Vanderbilt Univ, Med Ctr, Dept Med, Div Nephrol & Hypertens, Nashville, TN USA

[45] Icahn Sch Med Mt Sinai, Dept Genet & Genom Sci, New York, NY USA

[46] Univ Calif San Diego, La Jolla, CA USA

来源：

KIDNEY INTERNATIONAL REPORTS | 2023年 / 8卷 / 11期

关键词：

drug-induced acute kidney injury; nephrotoxicity; RISK; ADJUDICATION; SELECTION; SEPSIS;

D O I：

10.1016/j.ekir.2023.07.037

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Introduction: Drug-induced acute kidney injury (DI-AKI) is a frequent adverse event. The identification of DI-AKI is challenged by competing etiologies, clinical heterogeneity among patients, and a lack of accurate diagnostic tools. Our research aims to describe the clinical characteristics and predictive variables of DI-AKI.Methods: We analyzed data from the Drug-Induced Renal Injury Consortium (DIRECT) study (NCT02159209), an international, multicenter, observational cohort study of enriched clinically adjudicated DI-AKI cases. Cases met the primary inclusion criteria if the patient was exposed to at least 1 nephrotoxic drug for a minimum of 24 hours prior to AKI onset. Cases were clinically adjudicated, and inter-rater reliability (IRR) was measured using Krippendorff's alpha. Variables associated with DI-AKI were identified using L1 regularized multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (ROC AUC).Results: A total of 314 AKI cases met the eligibility criteria for this analysis, and 271 (86%) cases were adjudicated as DI-AKI. The majority of the AKI cases were recruited from the United States (68%). The most frequent causal nephrotoxic drugs were vancomycin (48.7%), nonsteroidal antiinflammatory drugs (18.2%), and piperacillin/tazobactam (17.8%). The IRR for DI-AKI adjudication was 0.309. The multivariable model identified age, vascular capacity, hyperglycemia, infections, pyuria, serum creatinine (SCr) trends, and contrast media as significant predictors of DI-AKI with good performance (ROC AUC 0.86).Conclusion: The identification of DI-AKI is challenging even with comprehensive adjudication by experienced nephrologists. Our analysis identified key clinical characteristics and outcomes of DI-AKI compared to other AKI etiologies.

引用

页码：2333 / 2344

页数：12

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