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

Figures & data

Table 1 The Baseline Characteristics of Elderly Patients with CA-AKI or Without AKI

Variable	Non-AKI Group	CA-AKI Group	P-value
Cases	28,824	2371
Age (years)	71 (65,78)	75 (67,81)	<0.001
Women, n (%)	9350 (32.44)	881(37.16)	<0.001
Past history, n (%)
Myocardial infarction	3281(11.38)	264 (11.13)	0.714
Congestive heart failure	8997 (31.21)	699 (26.48)	0.080
Peripheral vascular disease	6445 (22.36)	653 (27.54)	<0.001
Cerebrovascular disease	6470 (22.45)	653 (27.54)	<0.001
Diabetes without complications	8415 (29.19)	758 (31.97)	0.004
Diabetes with complications	878 (3.05)	135 (5.69)	<0.001
Connective tissue disease	1132 (3.93)	165 (6.96)	<0.001
Peptic ulcer	860 (2.98)	123 (5.19)	<0.001
Liver diseases	271 (0.94)	77 (3.23)	<0.001
Malignant tumor	1060 (3.68)	244 (10.29)	<0.001
Hypertension	18,078 (62.72)	1336 (56.65)	<0.001
Community acquired pneumonia	989 (3.43)	221 (9.32)	<0.001
Chronic kidney disease	1558(5.41)	204 (8.60)	<0.001
Charlson comorbidity index score	2.37 ± 2.180	3.42 ± 2.566	<0.001

Abbreviations: CA-AKI, community-acquired acute kidney injury; Non-AKI, non-acute kidney injury.

Table 2 Suspected Nephrotoxic Drugs Use in Post-CA-AKI or Non-AKI Elderly Patients

Suspected Nephrotoxic Drugs [Case (%)]	Non-AKI Group	CA-AKI Group	P-value
	(n = 28,824)	(n = 2371)
Aminoglycosides	528 (1.83)	126 (5.31)	<0.001
Glycopeptide antibiotics	104 (0.36)	113 (4.77)	<0.001
Antifungal agents	46 (0.16)	42 (1.77)	<0.001
Beta lactam antibiotics	6274 (21.77)	1512 (63.77)	<0.001
Diuretics	6575 (22.81)	1024 (43.19)	<0.001
NSAIDs	20,005 (69.40)	1230 (51.88)	<0.001
Chemotherapeutic agents	506 (1.75)	54 (2.28)	0.066
Iodine contrast agent	3854 (13.37)	461 (8.78)	<0.001
ACEI or ARB	17,669 (61.30)	981 (41.37)	<0.001
Ferralia	127 (0.44)	31 (1.31)	<0.001
Adrenergic receptor agonists	1041 (3.61)	623 (26.28)	<0.001
Drugs for cardiac insufficiency therapy	35 (0.12)	48 (2.02)	<0.001
Category of suspected nephrotoxic drugs
1–2 categories	23,887 (82.87)	1353 (57.06)	<0.001
≥ 3 categories	4851 (16.83)	1017 (42.89)	<0.001

Abbreviations: Non-AKI, non-acute kidney injury; CA-AKI, community-acquired acute kidney injury; NSAIDs, non-steroidal anti-inflammatory drugs; ACEI or ARB: angiotensin converting enzyme inhibitors or angiotensin receptor antagonists.

Table 3 Clinical Outcomes in Patients with CA-AKI or Without AKI

Clinical Outcomes	Non-AKI Group	CA-AKI Group	P-value
	(n = 28,824)	(n = 2371)
Cardiogenic shock [n (%)]	14 (0.05)	38 (1.61)	0.001
MODS [n (%)]	12 (0.04)	142 (5.99)	<0.001
CPR [n (%)]	85 (0.29)	143 (6.03)	<0.001
ICU transfer [n (%)]	1231 (4.27)	501 (21.13)	<0.001
Hemodialysis [n (%)]	1 (0.003)	247 (10.42)	<0.001
IABP [n (%)]	78 (0.27)	47 (1.98)	<0.001
In-hospital mortality [n (%)]	124 (0.43)	230 (9.71)	<0.001
Length of hospital stay (d,× ± s)	8.30 ± 5.43	14.46 ± 6.85	<0.001
Hospitalized costs (10,000 yuan,× ± s)	3.81 ± 3.54	6.12 ± 5.61	<0.001

Abbreviations: Non-AKI, non-acute kidney injury; CA-AKI, community-acquired acute kidney injury; MODS, multiple organ dysfunctions; CPR, cardio-pulmonary resuscitation; ICU, intensive care unit; IABP, intra-aortic balloon pump.

Table 4 The Association of the Number of Suspected Nephrotoxic Drugs Use and Clinical Outcomes After CA-AKI in Elderly Patients

Number of Drugs	Length of Hospital Stay (d,× ± s)	Hospitalized Costs (10,000 Yuan,× ± s)	CPR [n (%)]	ICU Transfer [n (%)]	Hemodialysis [n (%)]	In-Hospital Mortality [n (%)]
1 drug (n=563)	12.42 ± 5.99 ^a	3.72 ± 3.03 ^a	9 (1.60) ^a	40 (7.10) ^a	24 (4.26) ^a	17 (3.02)^a
2 drugs (n=791)	13.77 ± 6.56 ^b	5.28 ± 4.53 ^b	28 (3.54) ^b	110 (13.91) ^b	60 (7.59) ^b	42 (5.31) ^b
≥3 drugs (n=1017)	16.13 ± 7.11 ^c	8.09 ± 6.68 ^c	106 (10.42) ^c	351 (34.51) ^c	163 (16.03) ^c	171 (16.81) ^c
F/χ^2trend	60.87	160.634	57.253	185.812	60.329	92.411
P -value	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Notes: In the same row, compared with ^bcdaP<0.05; compared with ^acdbP<0.05; compared with ^abdcP<0.05.

Abbreviations: CA-AKI, community-acquired acute kidney injury; CPR, cardio-pulmonary resuscitation; ICU, intensive care unit.

Table 5 Univariate and Multivariate Analysis of Risk Factors for in-Hospital Mortality

CA-AKI Variables	Univariate Analysis					Multivariable Analysis
	OR	95% CI		P-value		OR	95% CI		P-value
Gender	0.99	0.98	1.01	0.635		/	/	/	/
Age	1.03	1.02	1.05	<0.001		1.04	1.03	1.05	<0.001
MODS	22.24	15.26	32.4	<0.001		27.04	20.46	35.72	<0.001
Cardiogenic shock	14.05	7.26	27.17	<0.001		23.98	13.25	43.41	<0.001
Hypertension	0.91	0.70	1.20	0.52		/	/	/	/
Myocardial infarction	1.56	1.06	2.28	0.023		1.01	0.77	1.32	0.94
Congestive heart failure	1.28	0.96	1.71	0.089		/	/	/	/
Connective tissue disease	0.72	0.39	1.31	0.277		/	/	/	/
Ulcer disease	0.63	0.31	1.32	0.222		/	/	/	/
Liver disease	3.48	2.05	5.91	<0.001		4.01	2.78	5.78	<0.001
Diabetes mellitus	0.92	0.68	1.23	0.555		/	/	/	/
Cancer	2.22	1.55	3.19	<0.001		3.97	3.17	4.97	<0.001
CAP	2.12	1.45	3.10	<0.001		1.81	1.38	2.37	<0.001
Nephrotoxic drugs use						/	/	/	/
Continued use after CA-AKI	1.89	1.69	2.12	<0.001		1.60	1.50	1.72	<0.001
≥3 drugs	4.44	3.26	6.04	<0.001		3.31	2.76	3.97	<0.001

Abbreviations: CA-AKI, community-acquired acute kidney injury; MODS, multiple organ dysfunctions; CAP, community acquired pneumonia.