Drug-induced acute kidney injury in hospitalized patients: a retrospective study
10.3760/cma.j.cn114015-20190910-00753
- VernacularTitle:住院患者发生药源性急性肾损伤情况的回顾性分析
- Author:
Chen LIU
1
;
Di GAI
1
;
Suying YAN
1
;
Yuqin WANG
1
;
Xiaohui CUI
1
;
Yangxin ZHANG
1
Author Information
1. 首都医科大学宣武医院药剂科，北京 100053
- Publication Type:Journal Article
- Keywords:
Acute renal injury;
Inpatients;
Drug-induced diseases
- From:
Adverse Drug Reactions Journal
2020;22(4):247-251
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the occurrence of drug-induced acute kidney injury (AKI) in adult hospitalized patients in Xuanwu Hospital, Capital Medical University.Methods:All medical records of adult inpatients who were discharged from January 1, 2014 to December 31, 2014 and whose diagnosis were in accordance with AKI during their hospitalization in Xuanwu Hospital, Capital Medical University were collected. The patients were divided into drug-induced AKI group and non-drug-induced AKI group according to whether AKI was caused by drugs. Basic information, comorbidity, change in serum creatinine (Scr), disease outcome, nephrotoxic medication exposure, and evaluation of the relationship between drugs and AKI of the patients were collected and retrospectively analyzed.Results:A total of 592 patients enrolled in the study, including 138 (23.31%) in the drug-induced AKI group and 454 (76.69%) in the non-drug-induced AKI group. The differences in gender, age, days in hospital, comorbidity, Scr level on admission, time for Scr level to peak after admission, and outcome between the patients in the 2 groups were not statistically significant, respectively ( P>0.05 for all). Peak value of Scr during hospitalization and at discharge in patients in the drug-induced AKI group (178 μmol/L, 116 μmol/L) were obviously higher than those in the non-drug-induced AKI group (129 μmol/L, 103 μmol/L), and the differences were statistically significant ( P<0.001, P=0.001). A total of 231 times of suspected drugs were involved in the 138 patients in the drug-induced AKI group. The top 6 types of drugs in turn were anti-infectious agents (35.06%, 81/231), diuretics (17.32%, 40/231), contrast agents (13.42%, 31/231), plasma substitutes (9.96%, 23/231), angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blocker (8.23%, 19/231), and non-steroidal anti-inflammatory drugs (NSAIDs) (6.93%, 16/231). Contrast agents and plasma substitutes had the shortest (range: 1-3 days) but anti-infectious agents had the longest time (range: 1-12 days) from medication to AKI occurrence. Peak values of Scr in AKI inpatients caused by NSAIDs and contrast agents were lower [median value: 118 (103, 300) μmol/L, 133 (90, 243) μmol/L], but in those caused by anti-infectious agents was the highest [median value: 223 (138, 396) μmol/L]. Multivariate logistic regression analysis showed that hypoproteinemia ( OR=8.369, 95 %CI: 3.379-20.724, P<0.001) and advanced age ( OR=1.689, 95 %CI: 1.206-2.365, P=0.002 for every 10 years of aging) were independent risk factors related to the death of patients with drug-induced AKI. Conclusions:The patients with AKI induced by drugs accounts for 23.31% of all AKI adult inpatients in Xuanwu Hospital, Capital Medical University. Anti-infectious agents, diuretics, and contrast agents are the most common suspected pathogenic drugs. Hypoproteinemia and advanced age are independent risk factors for hospital deaths in drug-induced AKI patients.
