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Lee MY, Heo KN, Lee S, Ah YM, Shin J, Lee JY. Development and validation of a medication-based risk prediction model for acute kidney injury in older outpatients. Arch Gerontol Geriatr 2024; 120:105332. [PMID: 38382232 DOI: 10.1016/j.archger.2024.105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Older adults are at an increased risk of acute kidney injury (AKI), particularly in community settings, often due to medications. Effective prevention hinges on identifying high-risk patients, yet existing models for predicting AKI risk in older outpatients are scarce, particularly those incorporating medication variables. We aimed to develop an AKI risk prediction model that included medication-related variables for older outpatients. METHODS We constructed a cohort of 2,272,257 outpatients aged ≥65 years using a national claims database. This cohort was split into a development (70%) and validation (30%) groups. Our primary goal was to identify newly diagnosed AKI within one month of cohort entry in an outpatient context. We screened 170 variables and developed a risk prediction model using logistic regression. RESULTS The final model integrated 12 variables: 2 demographic, 4 comorbid, and 6 medication-related. It showed good performance with acceptable calibration. In the validation cohort, the area under the receiver operating characteristic curve value was 0.720 (95% confidence interval, 0.692-0.748). Sensitivity and specificity were 69.9% and 61.9%, respectively. Notably, the model identified high-risk patients as having a 27-fold increased AKI risk compared with low-risk individuals. CONCLUSION We have developed a new AKI risk prediction model for older outpatients, incorporating critical medication-related variables with good discrimination. This tool may be useful in identifying and targeting patients who may require interventions to prevent AKI in an outpatient setting.
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Affiliation(s)
- Mee Yeon Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Suhyun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | - Jaekyu Shin
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, United States
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
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2
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Komerdelj IA, Buckley MS, D'Alessio PA, Ziadat DS, Kobic E, Rangan P, Agarwal SK, Tinta NC, Yerondopoulos MJ, Kane-Gill SL. Vancomycin With Concomitant Piperacillin/Tazobactam vs. Cefepime or Meropenem Associated Acute Kidney Injury in General Ward Patients: A Multicenter Propensity Score-Matched Study. J Pharm Pract 2024; 37:80-87. [PMID: 36075000 DOI: 10.1177/08971900221125518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Concurrent administration of vancomycin and piperacillin/tazobactam (VAN+PTZ) may increase the risk of acute kidney injury (AKI) in hospitalized patients. Comprehensive characterization of VAN+PTZ associated AKI and recovery patterns remains lacking in previous reports. Objective: To compare the incidence of AKI associated with VAN+PTZ compared to either cefepime (CEF) or meropenem (MER) with VAN in adult general ward patients. Methods: A multicenter, retrospective, propensity score cohort study was conducted in non-critically ill adult patients. Included patients were concurrently administered VAN+PTZ or VAN+CEF/MER. Patients developing AKI ≤48 hours following combination therapy were excluded. The primary endpoint was to compare the incidence of AKI between study groups. Multivariable Cox regression modeling in predicting AKI was also conducted. Results: A total of 3199 patients met inclusion criteria and were evaluated. The incidence of AKI in VAN+PTZ and VAN+CEF/MER groups were 16.4% and 8.7%, respectively (P < .001). The onset to AKI was 1.8 days earlier with VAN+PTZ compared to VAN+CEF/MER (P < .001). Multivariable prediction model showed concomitant VAN+PTZ was identified as an independent risk factor of developing AKI (HR 2.34, 1.82-3.01, P < .001). The VAN+PTZ group experienced significantly higher rates of severe AKI (stage II or III) compared to the VAN+CEF/MER group (P = .002). No differences in the AKI recovery patterns were found between study groups. Conclusions: Concomitant VAN+PTZ in adult general ward patients was independently associated with an increased risk of AKI overall. More severe AKI was also associated with VAN+PTZ.
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Affiliation(s)
- Ivan A Komerdelj
- Department of Pharmacy, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Paul A D'Alessio
- Department of Pharmacy, Banner Baywood Medical Center, Mesa, AZ, USA
| | - Delia S Ziadat
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Emir Kobic
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Pooja Rangan
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
- Department of Medicine, University of Arizona-College of Medicine Phoenix, Phoenix, AZ, USA
| | - Sumit K Agarwal
- Department of Medicine, University of Arizona-College of Medicine Phoenix, Phoenix, AZ, USA
| | - Nicole C Tinta
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | | | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
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3
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Amatullah N, Stottlemyer B, Zerfas I, Stevens C, Ozrazgat-Baslanti T, Bihorac A, Kane-Gill SL. Challenges in Pharmacovigilance: Variability in the Criteria for Determining Drug-Associated Acute Kidney Injury in Retrospective, Observational Studies. Nephron Clin Pract 2023; 147:725-732. [PMID: 37607496 PMCID: PMC10776175 DOI: 10.1159/000531916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Drug-associated acute kidney injury (D-AKI) accounts for 19-26% of acute kidney injury (AKI) events in hospitalized patients and results in outcomes similar to patients with AKI from other etiologies. Diagnosing D-AKI is complex and various criteria have been used. SUMMARY To highlight the variability in D-AKI determination, a review was conducted between January 2017 and December 2022 using PubMed. Search terms included adaptations of "drug associated kidney injury" to identify a sampling of literature discussing definitions and criteria for D-AKI evaluation. The search yielded 291 articles that were uploaded to Rayyan, a software tool used to screen and select studies. Retrospective, observational electronic health record (EHR) studies conducted in hospitalized patients were included. The final sample contained 16 studies for data extraction, representing mostly adult populations (n = 13, 81.3%) in noncritical or unspecified inpatient settings (n = 12, 75%). Nine studies (56.3%) utilized the recommended Kidney Disease: Improving Global Outcome guidelines (KDIGO) criteria to define AKI. Baseline creatinine or laboratory criteria for kidney function were provided in 10 studies (62.5%). Eleven studies (68.8%) established a temporal sequence assessment linking nephrotoxin drug exposure to an AKI event, but these criteria were inconsistent among studies using time frames as soon as 3 months prior to AKI. CONCLUSION This review highlights the substantial variability in D-AKI criteria in select studies. Minimum expectations about what should be reported and criteria for the elements reported are needed to assure transparency, consistency, and standardization of pharmacovigilance strategies.
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Affiliation(s)
- Nabihah Amatullah
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Britney Stottlemyer
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Isabelle Zerfas
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cole Stevens
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tezcan Ozrazgat-Baslanti
- Intelligent Critical Care Center, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Azra Bihorac
- Intelligent Critical Care Center, University of Florida, Gainesville, Florida, USA
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacy, UPMC, Pittsburgh, PA, USA
- Department of Critical Care Medicine, Program of Critical Care Nephrology, Pittsburgh, PA, USA
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Akimoto H, Hayakawa T, Nagashima T, Minagawa K, Takahashi Y, Asai S. Detection of potential drug-drug interactions for risk of acute kidney injury: a population-based case-control study using interpretable machine-learning models. Front Pharmacol 2023; 14:1176096. [PMID: 37288110 PMCID: PMC10242015 DOI: 10.3389/fphar.2023.1176096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Background: Acute kidney injury (AKI), with an increase in serum creatinine, is a common adverse drug event. Although various clinical studies have investigated whether a combination of two nephrotoxic drugs has an increased risk of AKI using traditional statistical models such as multivariable logistic regression (MLR), the evaluation metrics have not been evaluated despite the fact that traditional statistical models may over-fit the data. The aim of the present study was to detect drug-drug interactions with an increased risk of AKI by interpreting machine-learning models to avoid overfitting. Methods: We developed six machine-learning models trained using electronic medical records: MLR, logistic least absolute shrinkage and selection operator regression (LLR), random forest, extreme gradient boosting (XGB) tree, and two support vector machine models (kernel = linear function and radial basis function). In order to detect drug-drug interactions, the XGB and LLR models that showed good predictive performance were interpreted by SHapley Additive exPlanations (SHAP) and relative excess risk due to interaction (RERI), respectively. Results: Among approximately 2.5 million patients, 65,667 patients were extracted from the electronic medical records, and assigned to case (N = 5,319) and control (N = 60,348) groups. In the XGB model, a combination of loop diuretic and histamine H2 blocker [mean (|SHAP|) = 0.011] was identified as a relatively important risk factor for AKI. The combination of loop diuretic and H2 blocker showed a significant synergistic interaction on an additive scale (RERI 1.289, 95% confidence interval 0.226-5.591) also in the LLR model. Conclusion: The present population-based case-control study using interpretable machine-learning models suggested that although the relative importance of the individual and combined effects of loop diuretics and H2 blockers is lower than that of well-known risk factors such as older age and sex, concomitant use of a loop diuretic and histamine H2 blocker is associated with increased risk of AKI.
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Affiliation(s)
- Hayato Akimoto
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Takashi Hayakawa
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Takuya Nagashima
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Kimino Minagawa
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yasuo Takahashi
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Satoshi Asai
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
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5
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Guo H, Li P, Guo D, Gao A, Zhao P, Fu A, Li C, Lu J. Analysis of clinical characteristics and automatic monitoring of drug-induced arrhythmias in 167,546 inpatients. Eur J Clin Pharmacol 2023; 79:759-765. [PMID: 37039873 DOI: 10.1007/s00228-023-03492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze the occurrence characteristics, clinical manifestations, medication distribution, and incidence of drug-induced arrhythmias in a real-world inpatient population. METHODS According to the inclusion and exclusion criteria as well as the ADR evaluation criteria, we retrospectively evaluated hospitalized patients in 2019 using the arrhythmia module of the Adverse Drug Event Active Surveillance and Assessment System-II (ADE-ASAS-II). A detailed analysis was performed on the demographic data, ADR manifestations, and medication distribution of 2097 patients with drug-induced arrhythmias and QT interval prolongation. RESULTS Of the 167,546 hospitalized patients, there were 1809 cases of drug-induced arrhythmias, with an incidence of 1.08%. The ADRs in 45.35% of positive patients occurred within 3 days after medication administration, and 46.73% of the patients were 65 years old or older. The predominant ADRs identified in this study were extrasystole, tachycardia, and QT interval prolongation, of which the incidence was 0.20%. Levofloxacin was the most involved drug, and levofloxacin-associated rates of incidence of arrhythmia and QT interval prolongation were 1.24% and 0.44%, respectively. The risk factors for drug-induced arrhythmias were male sex, advanced age, emaciation, obesity, and underlying illnesses such as cardiovascular diseases, diabetes mellitus, cerebrovascular diseases, and hepatic and renal inadequacy (P < 0.05). CONCLUSION The incidence of drug-induced arrhythmias was in the range of common, while QTc interval prolongation was occasional. It is necessary to pay attention to patients with risk factors.
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Affiliation(s)
- Haili Guo
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Li
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Daihong Guo
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Ao Gao
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Pengzhi Zhao
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - An Fu
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Chao Li
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jingchuang Lu
- Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, 100853, China
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
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6
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Hu B, Ye L, Li T, Feng Z, Huang L, Guo C, He L, Tan W, Yang G, Li Z, Guo C. Drug-induced kidney injury in Chinese critically ill pediatric patients. Front Pharmacol 2022; 13:993923. [PMID: 36225556 PMCID: PMC9548562 DOI: 10.3389/fphar.2022.993923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Drug-induced acute kidney injury (DIKI) is a common adverse drug reaction event but is less known in pediatric patients. The study explored the DIKI in Chinese pediatric patients using the Pediatric Intensive Care database (PIC). Method: We screened pediatric patients with acute kidney injury (AKI) using the KDIGO criteria from the PIC and then assessed the relationship between their drugs and DIKI using the Naranjo scale. For the fifteen frequently used DIKI-suspected drugs, we divided patients into drug-exposed and non-exposed groups, using the outcome of whether DIKI was presented or not. Propensity score matching (PSM) was used to control for the effects of four confounders, age, gender, length of hospital stay, and major diagnosis. Unconditional logistic regression was used to identify statistically significant differences between the two groups. Results: A total of 238 drugs were used 1,863 times by the 81 patients with DIKI during their hospital stay. After screening the Naranjo scale to identify the top 15 suspected DIKI drugs with a high frequency of use, we found that furosemide injection (p = 0.001), midazolam injection (p = 0.001), 20% albumin prepared from human plasma injection (p = 0.004), fentanyl citrate injection (p = 0.001), compound glycyrrhizin injection (p = 0.026), vancomycin hydrochloride for intravenous (p = 0.010), and milrinone lactate injection (p = 0.009) were associated with DIKI. Conclusion: In critically ill pediatric patients, DIKI is more likely to occur after using furosemide injection, midazolam injection, 20% albumin prepared from human plasma injection, fentanyl citrate injection, compound glycyrrhizin injection, vancomycin hydrochloride for intravenous, milrinone lactate injection.
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Affiliation(s)
- Biwen Hu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Ye
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tong Li
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zeying Feng
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Longjian Huang
- West Guangxi Key Laboratory for Prevention and Treatment of High-Incidence Diseases, Youjiang Medical University for Nationalities, Baise, China
| | - Chengjun Guo
- School of Applied Mathematics, Guangdong University of Technology, Guangzhou, China
| | - Li He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Tan
- Department of Neonatology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Region, China
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiling Li
- Department of Pharmacy, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chengxian Guo
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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7
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Lin L, Tian E, Ren J, Wu Z, Deng J, Yang J. Traditional Chinese Medicine in Treating Primary Podocytosis: From Fundamental Science to Clinical Research. Front Pharmacol 2022; 13:932739. [PMID: 36003509 PMCID: PMC9393213 DOI: 10.3389/fphar.2022.932739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Podocytes form a key component of the glomerular filtration barrier. Damage to podocytes is referred to as “podocyte disease.” There are many causes of podocyte injury, including primary injury, secondary injury, and gene mutations. Primary podocytosis mostly manifests as nephrotic syndrome. At present, first-line treatment is based on glucocorticoid administration combined with immunosuppressive therapy, but some patients still progress to end-stage renal disease. In Asia, especially in China, traditional Chinese medicine (TCM) still plays an important role in the treatment of kidney diseases. This study summarizes the potential mechanism of TCM and its active components in protecting podocytes, such as repairing podocyte injury, inhibiting podocyte proliferation, reducing podocyte apoptosis and excretion, maintaining podocyte skeleton structure, and upregulating podocyte-related protein expression. At the same time, the clinical efficacy of TCM in the treatment of primary podocytosis (including idiopathic membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis) is summarized to support the development of new treatment strategies for primary podocytosis.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - En Tian
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Jiangwen Ren
- Department of Nephrology, Rheumatism and Immunology, Jiulongpo District People’s Hospital of Chongqing, Chongqing, China
| | - Zhifeng Wu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | | | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
- *Correspondence: Jurong Yang,
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8
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Drożdżal S, Lechowicz K, Szostak B, Rosik J, Kotfis K, Machoy‐Mokrzyńska A, Białecka M, Ciechanowski K, Gawrońska‐Szklarz B. Kidney damage from nonsteroidal anti-inflammatory drugs-Myth or truth? Review of selected literature. Pharmacol Res Perspect 2021; 9:e00817. [PMID: 34310861 PMCID: PMC8313037 DOI: 10.1002/prp2.817] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely available drugs with anti-inflammatory and analgesic properties. Their mechanism of action is associated with the enzymes of the arachidonic acid cycle (cyclooxygenases: COX-1 and COX-2). The cyclooxygenase pathway results in the formation of prostanoids (prostaglandins [PGs], prostacyclins, and thromboxanes). It affects various structures of the human body, including the kidneys. Medical literature associates the usage of NSAIDs with acute kidney injury (AKI), tubulointerstitial nephritis (TIN), as well as nephrotic syndrome and chronic kidney disease (CKD). AKI associated with the chronic consumption of NSAIDs is mainly attributed to pharmacological polytherapy and the presence of cardiovascular or hepatic comorbidities. The pathomechanism of AKI and CKD is associated with inhibition of the biosynthesis of prostanoids involved in the maintenance of renal blood flow, especially PGE2 and PGI2. It is suggested that both COX isoforms play opposing roles in renal function, with natriuresis increased by COX-1 inhibition followed by a drop in a blood pressure, whereas COX-2 inhibition increases blood pressure and promotes sodium retention. TIN after NSAID use is potentially associated with glomerular basement membrane damage, reduction in pore size, and podocyte density. Therefore, nephrotic proteinuria and impairment of renal function may occur. The following article analyzes the association of NSAIDs with kidney disease based on available medical literature.
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Affiliation(s)
- Sylwester Drożdżal
- Department of Pharmacokinetics and Monitored TherapyPomeranian Medical UniversitySzczecinPoland
| | - Kacper Lechowicz
- Department of Anaesthesiology, Intensive Therapy and Acute IntoxicationsPomeranian Medical UniversitySzczecinPoland
| | - Bartosz Szostak
- Department of PhysiologyPomeranian Medical UniversitySzczecinPoland
| | - Jakub Rosik
- Department of PhysiologyPomeranian Medical UniversitySzczecinPoland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute IntoxicationsPomeranian Medical UniversitySzczecinPoland
| | - Anna Machoy‐Mokrzyńska
- Department of Experimental and Clinical PharmacologyPomeranian Medical UniversitySzczecinPoland
| | - Monika Białecka
- Department of Pharmacokinetics and Monitored TherapyPomeranian Medical UniversitySzczecinPoland
| | - Kazimierz Ciechanowski
- Department of Nephrology, Transplantology and Internal MedicinePomeranian Medical UniversitySzczecinPoland
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9
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Yu C, Guo D, Yao C, Zhu Y, Liu S, Kong X. Development and Validation of a Nomogram for Predicting Drug-Induced Acute Kidney Injury in Hospitalized Patients: A Case-Control Study Based on Propensity-Score Matching. Front Pharmacol 2021; 12:657853. [PMID: 34194322 PMCID: PMC8238493 DOI: 10.3389/fphar.2021.657853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Drug-induced acute kidney injury (D-AKI) is associated with increased mortality and longer hospital stays. This study aims to establish a nomogram to predict the occurrence of D-AKI in hospitalized patients in a multi-drug environment. Methods: A single center retrospective study among adult hospitalized patients was conducted from July 2019 to September 2019 based on the Adverse Drug Events Active Surveillance and Assessment System-2 developed by our hospital. According to the propensity score matching algorithm, four controls per case were matched to eliminate the confounding bias caused by individual baseline variables. The predictors for D-AKI were obtained by logistic regression equation and used to establish the nomogram. Results: Among 51,772 hospitalized patients, 332 were diagnosed with D-AKI. After matching, 288 pairs and 1,440 patients were included in the study, including 1,005 cases in the development group and 435 cases in the validation group. Six variables were independent predictors for D-AKI: alcohol abuse, the concurrent use of nonsteroidal anti-inflammatory drugs or diuretics, chronic kidney disease, lower baseline red blood cell count and neutrophil count ≥7 × 109/L. The area under the curve (AUC) of the prediction model in the development group and validation group were 0.787 (95%CI, 0.752–0.823) and 0.788 (95%CI, 0.736–0.840), respectively. The GiViTI calibration belts showed that the model had a good prediction accuracy for the occurrence of D-AKI (p > 0.05). Conclusion: This nomogram can help identify patients at high risk of D-AKI, which was useful in preventing the progression of D-AKI and treating it in the early stages.
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Affiliation(s)
- Chengxuan Yu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Daihong Guo
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China
| | - Chong Yao
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China
| | - Yu Zhu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Siyuan Liu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Xianghao Kong
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,College of Pharmacy, Chongqing Medical University, Chongqing, China
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10
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Kong X, Guo D, Liu S, Zhu Y, Yu C. Incidence, characteristics and risk factors for drug-induced liver injury in hospitalized patients: A matched case-control study. Br J Clin Pharmacol 2021; 87:4304-4312. [PMID: 33948989 DOI: 10.1111/bcp.14847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS The diagnosis of drug-induced liver injury (DILI) is relatively complex and involves a wide variety of drugs. The purpose of this study was to use algorithms to quickly screen DILI patients, determine its incidence and identify risk factors. METHODS The Adverse Drug Events Active Surveillance and Assessment System-2 was used to extract the data of patients hospitalized in 2019 according to the set standards and the Roussel Uclaf Causality Assessment Method was used to evaluate patients who met the standards. A retrospective case-control study was conducted according to suspected drugs, length of hospital stay and height- and weight-matched controls, and logistic regression was used to identify risk factors. RESULTS Among the 156 570 hospitalized patients, 480 patients (499 cases) with DILI were confirmed and the incidence of DILI was 0.32%. Anti-infective agents, antineoplastic agents and nonsteroidal anti-inflammatory drugs were the major categories of drugs causing DILI, and the highest incidence of DILI was due to voriconazole. The latency period and hospital stay of patients with cholestasis were both relatively long. Patients with hyperlipidaemia (adjusted odds ratio [AOR] 1.884), cardiovascular disease (AOR 1.465), pre-existing liver disease (AOR 1.827) and surgical history (AOR 1.312) were at higher risk for DILI. CONCLUSIONS The incidence of DILI in hospitalized patients was uncommon (0.32%) and its pathogenic drugs were widely distributed. The incidence of DILI for many drugs has been seriously underestimated. It is recommended to focus on patients with hyperlipidaemia, cardiovascular disease, pre-existing liver disease and surgical history.
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Affiliation(s)
- Xianghao Kong
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China.,College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Daihong Guo
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Siyuan Liu
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Zhu
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chengxuan Yu
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
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