Community-Acquired Acute Kidney Injury Induced By Drugs In Older Patients: A Multifactorial Event

Clin Interv Aging. 2019 Dec 5:14:2105-2113. doi: 10.2147/CIA.S217567. eCollection 2019.

Abstract

Purpose: Community-acquired acute kidney injury (CA-AKI) is a frequent and severe adverse drug reaction (ADR) among older patients. The combination of drugs and other CA-AKI risk factors was barely evaluated. The objectives of our study were to both accurately identify CA-AKI induced by drugs in older patients, and to describe their combination with other risk factors.

Patients and methods: We conducted a retrospective, single-center study in a general hospital over a two-year period. An automated detection identified CA-AKI according to KDIGO criteria, amongst 4,767 eligible inpatient stays among patients aged 75 years or older. Two independent experts reviewed all CA-AKI events to adjudicate drug involvement (Naranjo scale), identify inappropriate prescriptions (STOPP criteria), evaluate avoidability (Hallas criteria) and identify combined risk factors.

Results: An expert review confirmed 713 CA-AKI (15.0% of inpatient stays) and determined that 419 (58.8%) CA-AKI were induced by drugs. A multifactorial cause (i.e., at least one drug with a precipitating factor) was found in 63.2% of drug-induced CA-AKI. Most of the drug-induced events were avoidable (66.8%), mainly in relation to a multifactorial cause.

Conclusion: Drug-induced CA-AKI were frequent, multifactorial events in hospitalized older patients and their prevention should focus on combinations with precipitating factors.

Keywords: acute kidney injury; adverse drug reactions; elderly; prevention.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Aged
  • Aged, 80 and over
  • Drug-Related Side Effects and Adverse Reactions / diagnosis*
  • Female
  • France
  • Humans
  • Inappropriate Prescribing / adverse effects
  • Male
  • Retrospective Studies
  • Risk Factors

Grants and funding

This study was funded by the Fondation pour la Recherche Médicale (FRM). The FRM did not influence study design, analysis, data collection and presentation or interpretation of the results. The FRM did not review the manuscript prior to its publication.