Affiliation:
1. Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
2. Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans' Affairs Health Care System, Iowa City, Iowa
3. Division of Nephrology and Hypertension, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
4. Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
Abstract
Background
Rates of nephrotoxic AKI are not well described in adults due to lack of a clear definition, debate over which drugs should be considered nephrotoxins, and illness-related confounding. Nephrotoxic Injury Negated by Just-in Time Action (NINJA), a program that reduces rates of nephrotoxic AKI in pediatric populations, may be able to address these concerns, but whether NINJA can be effectively applied to adults remains unclear.
Methods
In this retrospective cohort study conducted at the University of Iowa Hospital, we included adult patients admitted to a general hospital floor for ≥48 hours during 2019. The NINJA algorithm screened charts for high nephrotoxin exposure and AKI. After propensity score matching, Cox proportional hazard modeling was used to evaluate the relationship between nephrotoxic exposure and all-stage AKI, stage 2–3 AKI, or death. Additional analyses evaluated the most frequent nephrotoxins used in this population.
Results
Of 11,311 patients, 1527 (16%) had ≥1 day of high nephrotoxin exposure. Patients with nephrotoxic exposures subsequently developed AKI in 29% of cases, and 22% of all inpatient AKI events met nephrotoxic AKI criteria. Common nephrotoxins were vancomycin, iodinated contrast dye, piperacillin-tazobactam, acyclovir, and lisinopril. After propensity score matching, Cox proportional hazard models for high nephrotoxin exposure were significantly associated with all AKI (hazard ratio [HR] 1.43, 1.19–1.72, P<0.001), stage 2–3 AKI (HR 1.78, 1.18–2.67, P=0.006), and mortality (HR 2.12, 1.09–4.11, P=0.03).
Conclusions
Nephrotoxin exposure in adults is common and is significantly associated with AKI development, including stage 2–3 AKI.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Transplantation,Nephrology,Critical Care and Intensive Care Medicine,Epidemiology
Cited by
3 articles.
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