Risk of Acute Kidney Injury Associated With Medication Administration in the Emergency Department.

Autor: Hinson JS; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland., Ehmann MR; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland., Al Jalbout N; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland., Ortmann MJ; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland., Zschoche J; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland., Klein EY; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Disease Dynamics, Economics and Policy, Washington, District of Columbia.
Jazyk: angličtina
Zdroj: The Journal of emergency medicine [J Emerg Med] 2020 Mar; Vol. 58 (3), pp. 487-496. Date of Electronic Publication: 2020 Jan 15.
DOI: 10.1016/j.jemermed.2019.11.034
Abstrakt: Background: Patients who develop acute kidney injury (AKI) have a 2-fold increased risk for major adverse events within 1 year. An estimated 19-26% of all cases of hospital-acquired AKI may be attributable to drug-induced kidney disease (DIKD). Patients evaluated in the emergency department (ED) are often prescribed potentially nephrotoxic drugs, yet the role of ED prescribing in DIKD is unknown.
Objective: We sought to measure the association between ED medication administration and development of AKI.
Methods: This was a retrospective 5-year cohort analysis at a single center. Patients with a serum creatinine measurement at presentation in the ED and 24-168 h later were included. Outcome was incidence of AKI as defined by Kidney Disease Improving Global Outcomes criteria in the 7 days after ED evaluation. Medication administration risk was estimated using Cox proportional hazards model.
Results: There were 46,965 ED encounters by 30,407 patients included in the study, of which 6461 (13.8%) patients met the criteria for AKI. For hospitalized patients, administration of a potentially nephrotoxic medication was associated with increased risk of AKI (hazard ratio [HR] 1.30 [95% confidence interval {CI} 1.20-1.41]). Diuretics were associated with the largest risk of AKI (HR 1.64 [95% CI 1.52-1.78]), followed by angiotensin-converting enzyme inhibitors (HR 1.39 [95% CI 1.26-1.54]) and antibiotics (HR 1.13 [95% CI 1.05-1.22]). For discharged patients, administration of antibiotics was strongly associated with increased risk of AKI (HR 3.19 [95% CI 1.08-9.43]).
Conclusion: ED administration of potentially nephrotoxic medications was associated with an increased risk of AKI in the following 7 days. Diuretics, angiotensin-converting enzyme inhibitors, and antibiotics were independently associated with increased risk of AKI. Nephroprotective practices in the ED may mitigate kidney injury and long-term adverse outcomes.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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