The Incidence, Characteristics, and Use of Suspected Nephrotoxic Drugs in Elderly Patients with Community-Acquired Acute Kidney Injury

Abstract

Purpose

Acute kidney injury (AKI) is a major health problem with poor prognosis. However, little is known about elderly community-acquired-AKI (CA-AKI). This study aimed to investigate the incidence, clinical characteristics, outcomes and use of suspected nephrotoxic medications after CA-AKI in the elderly.

Materials and Methods

A total of 36,445 patients aged over 60 years were recruited from 2013 to 2016. Through an electronic database, we collected the demographic and medical history data, and admission lab results from all patients.

Results

A total of 2371 patients with CA-AKI were identified. The incidence of CA-AKI was 26.03% in the elderly. The proportion of CA-AKI patients with chronic comorbidities and Charlson comorbidity index score were higher than that of non-AKI patients. After CA-AKI, the proportions of exposure to non-steroidal anti-inflammatory drugs (NSAIDs), iodine contrast agent, angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) were significantly decreased (p < 0.001). However, the proportion of other possible nephrotoxic drugs (including aminoglycosides, glycopeptide antibiotics, antifungal agents, beta lactam antibiotics, diuretic, ferralia, adrenergic receptor agonists and drugs for cardiac insufficiency therapy) still increased after CA-AKI (p < 0.001). Compared with non-AKI patients, CA-AKI patients had higher percentage of cardiogenic shock, multiple organ failure, transferring to intensive care unit, cardio-pulmonary resuscitation, hemodialysis, and mortality (p < 0.001). Moreover, CA-AKI patients had worse prognosis when more kinds of suspected nephrotoxic drugs were used (p < 0.001).

Conclusion

The incidence of CA-AKI in the elderly was high, with more complex chronic complications and poor clinical outcomes. The use of most suspected nephrotoxic drugs still increased and was associated with worse prognosis after CA-AKI.

Keywords:

• acute kidney injury
• community-acquired acute kidney injury
• elderly
• prognosis
• nephrotoxic drug

Acknowledgment

We acknowledge the role of all patients, investigators, and support staff in performing the study.

These authors are considered as co-first authors: Wenxue Hu and Xingji Lian.

Abbreviations

AKI, acute kidney injury; CA-AKI, community-acquired-AKI; Scr, serum creatine; eGFR, estimated glomerular filtration rate; CKD-EPI, chronic kidney disease epidemiology collaboration equation; CCI, Charlson co-morbidity index; CKD, chronic kidney disease; IQR, interquartile range; NSAIDs, non-steroidal anti-inflammatory drugs; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; IABP, intra-aortic balloon pump; MODS, multiple organ dysfunctions.

Data Sharing Statement

Restrictions apply to the availability of data generated or analyzed during this study to preserve participant confidentiality. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.

Ethics Approval and Informed Consent

The study was conducted in compliance with the Helsinki declaration and approved by the Ethical Committee of Guangdong Provincial People’s Hospital (GDREC2016327H; Guangdong, China). Requirements for written informed consent were waived because all personal data were deidentified before the analyses.

Disclosure

The authors report no conflicts of interest for this work.