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

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:

• adverse drug reactions
• elderly
• prevention
• acute kidney injury

Acknowledgments

We sincerely thank all the physicians who participated in the Patient Safety through Intelligent Procedure (PSIP) project in their respective departments, notably, Dr. Pascale Leurs, Dr. Olivier Brimont, Dr. Zine Baarir, and Dr. Philippe Lecocq. We thank Renaud Perichon and Sophie Quenton (health informatics engineers) for their invaluable assistance. We also thank Laurie Ferret and Joanna Dupont for preliminary work.

Author Contributions

All authors contributed to the conception, design of the study or acquisition of data, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Dr. Jean-Baptiste Beuscart reports grants from Fondation pour la Recherche Médicale, during the conduct of the study. The authors report no other conflicts of interest in this work.