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Gray MP, Kellum JA, Kirisci L, Boyce RD, Kane-Gill SL. Long-Term Outcomes Associated With β-Lactam Allergies. JAMA Netw Open 2024; 7:e2412313. [PMID: 38758551 PMCID: PMC11102016 DOI: 10.1001/jamanetworkopen.2024.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/19/2024] [Indexed: 05/18/2024] Open
Abstract
Importance β-lactam (BL) allergies are the most common drug allergy worldwide, but most are reported in error. BL allergies are also well-established risk factors for adverse drug events and antibiotic-resistant infections during inpatient health care encounters, but the understanding of the long-term outcomes of patients with BL allergies remains limited. Objective To evaluate the long-term clinical outcomes of patients with BL allergies. Design, Setting, and Participants This longitudinal retrospective cohort study was conducted at a single regional health care system in western Pennsylvania. Electronic health records were analyzed for patients who had an index encounter with a diagnosis of sepsis, pneumonia, or urinary tract infection between 2007 and 2008. Patients were followed-up until death or the end of 2018. Data analysis was performed from January 2022 to January 2024. Exposure The presence of any BL class antibiotic in the allergy section of a patient's electronic health record, evaluated at the earliest occurring observed health care encounter. Main Outcomes and Measures The primary outcome was all-cause mortality, derived from the Social Security Death Index. Secondary outcomes were defined using laboratory and microbiology results and included infection with methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, or vancomycin-resistant Enterococcus (VRE) and severity and occurrence of acute kidney injury (AKI). Generalized estimating equations with a patient-level panel variable and time exposure offset were used to evaluate the odds of occurrence of each outcome between allergy groups. Results A total of 20 092 patients (mean [SD] age, 62.9 [19.7] years; 12 231 female [60.9%]), of whom 4211 (21.0%) had BL documented allergy and 15 881 (79.0%) did not, met the inclusion criteria. A total of 3513 patients (17.5%) were Black, 15 358 (76.4%) were White, and 1221 (6.0%) were another race. Using generalized estimating equations, documented BL allergies were not significantly associated with the odds of mortality (odds ratio [OR], 1.02; 95% CI, 0.96-1.09). BL allergies were associated with increased odds of MRSA infection (OR, 1.44; 95% CI, 1.36-1.53), VRE infection (OR, 1.18; 95% CI, 1.05-1.32), and the pooled rate of the 3 evaluated antibiotic-resistant infections (OR, 1.33; 95% CI, 1.30-1.36) but were not associated with C difficile infection (OR, 1.04; 95% CI, 0.94-1.16), stage 2 and 3 AKI (OR, 1.02; 95% CI, 0.96-1.10), or stage 3 AKI (OR, 1.06; 95% CI, 0.98-1.14). Conclusions and Relevance Documented BL allergies were not associated with the long-term odds of mortality but were associated with antibiotic-resistant infections. Health systems should emphasize accurate allergy documentation and reduce unnecessary BL avoidance.
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Affiliation(s)
- Matthew P. Gray
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - John A. Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Levent Kirisci
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Richard D. Boyce
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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Saraiva IE, Hamahata N, Huang DT, Kane-Gill SL, Rivosecchi RM, Shiva S, Nolin TD, Chen X, Minturn J, Chang CCH, Li X, Kellum J, Gómez H. Metformin for sepsis-associated AKI: a protocol for the Randomized Clinical Trial of the Safety and FeasibiLity of Metformin as a Treatment for sepsis-associated AKI (LiMiT AKI). BMJ Open 2024; 14:e081120. [PMID: 38688665 PMCID: PMC11086423 DOI: 10.1136/bmjopen-2023-081120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a common complication of sepsis associated with increased risk of death. Preclinical data and observational human studies suggest that activation of AMP-activated protein kinase, an ubiquitous master regulator of energy that can limit mitochondrial injury, with metformin may protect against sepsis-associated AKI (SA-AKI) and mortality. The Randomized Clinical Trial of the Safety and FeasibiLity of Metformin as a Treatment for sepsis-associated AKI (LiMiT AKI) aims to evaluate the safety and feasibility of enteral metformin in patients with sepsis at risk of developing SA-AKI. METHODS AND ANALYSIS Blind, randomised, placebo-controlled clinical trial in a single-centre, quaternary teaching hospital in the USA. We will enrol adult patients (18 years of age or older) within 48 hours of meeting Sepsis-3 criteria, admitted to intensive care unit, with oral or enteral access. Patients will be randomised 1:1:1 to low-dose metformin (500 mg two times per day), high-dose metformin (1000 mg two times per day) or placebo for 5 days. Primary safety outcome will be the proportion of metformin-associated serious adverse events. Feasibility assessment will be based on acceptability by patients and clinicians, and by enrolment rate. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board. All patients or surrogates will provide written consent prior to enrolment and any study intervention. Metformin is a widely available, inexpensive medication with a long track record for safety, which if effective would be accessible and easy to deploy. We describe the study methods using the Standard Protocol Items for Randomized Trials framework and discuss key design features and methodological decisions. LiMiT AKI will investigate the feasibility and safety of metformin in critically ill patients with sepsis at risk of SA-AKI, in preparation for a future large-scale efficacy study. Main results will be published as soon as available after final analysis. TRIAL REGISTRATION NUMBER NCT05900284.
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Affiliation(s)
- Ivan E Saraiva
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Natsumi Hamahata
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David T Huang
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sandra L Kane-Gill
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Ryan M Rivosecchi
- Department of Pharmacy, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Sruti Shiva
- Department of Pharmacology & Chemical Biology, Vascular Medical Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas D Nolin
- Department of Pharmacy & Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xinlei Chen
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Minturn
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chung-Chou H Chang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Xiaotong Li
- Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - John Kellum
- Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hernando Gómez
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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3
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Manis MM, Skelley JW, Read JB, Maxson R, O'Hagan E, Wallace JL, Siew ED, Barreto EF, Silver SA, Kane-Gill SL, Neyra JA. Role of a Pharmacist in Postdischarge Care for Patients With Kidney Disease: A Scoping Review. Ann Pharmacother 2024:10600280241240409. [PMID: 38563565 DOI: 10.1177/10600280241240409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The objective was to explore and describe the role of pharmacists in providing postdischarge care to patients with kidney disease. DATA SOURCES PubMed, Embase (Elsevier), CINAHL (Ebscohost), Web of Science Core Collection, and Scopus were searched on January 30, 2023. Publication date limits were not included. Search terms were identified based on 3 concepts: kidney disease, pharmacy services, and patient discharge. Experimental, quasi-experimental, observational, and qualitative studies, or study protocols, describing the pharmacist's role in providing postdischarge care for patients with kidney disease, excluding kidney transplant recipients, were eligible. STUDY SELECTION AND DATA EXTRACTION Six unique interventions were described in 10 studies meeting inclusion criteria. DATA SYNTHESIS Four interventions targeted patients with acute kidney injury (AKI) during hospitalization and 2 evaluated patients with pre-existing chronic kidney disease. Pharmacists were a multidisciplinary care team (MDCT) member in 5 interventions and were the sole provider in 1. Roles commonly identified include medication review, medication reconciliation, medication action plan formation, kidney function assessment, drug dose adjustments, and disease education. Some studies showed improvements in diagnostic coding, laboratory monitoring, medication therapy problem (MTP) resolution, and patient education; prevention of hospital readmission was inconsistent. Limitations include lack of standardized reporting of kidney disease, transitions of care processes, and differences in outcomes evaluated. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review identifies potential roles of a pharmacist as part of a postdischarge MDCT for patients with varying degrees of kidney disease. CONCLUSIONS The pharmacist's role in providing postdischarge care to patients with kidney disease is inconsistent. Multidisciplinary care teams including a pharmacist provided consistent identification and resolution of MTPs, improved patient education, and increased self-awareness of diagnosis.
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Affiliation(s)
- Melanie M Manis
- Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica W Skelley
- Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - J Braden Read
- Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - Rebecca Maxson
- Department of Pharmacy Practice, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Emma O'Hagan
- Department of Libraries, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica L Wallace
- Department of Pharmacy Practice, College of Pharmacy, Lipscomb University, Nashville, TN, USA
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Health Systems (TVHS), Nashville Veterans Affairs Medical Center, Nashville, TN, USA
| | | | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Hume NE, Zerfas I, Wong A, Klein-Fedyshin M, Smithburger PL, Buckley MS, Devlin JW, Kane-Gill SL. Clinical Impact of the Implementation Strategies Used to Apply the 2013 Pain, Agitation/Sedation, Delirium or 2018 Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption Guideline Recommendations: A Systematic Review and Meta-Analysis. Crit Care Med 2024; 52:626-636. [PMID: 38193764 PMCID: PMC10939834 DOI: 10.1097/ccm.0000000000006178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES To summarize the effectiveness of implementation strategies for ICU execution of recommendations from the 2013 Pain, Agitation/Sedation, Delirium (PAD) or 2018 PAD, Immobility, Sleep Disruption (PADIS) guidelines. DATA SOURCES PubMed, CINAHL, Scopus, and Web of Science were searched from January 2012 to August 2023. The protocol was registered with PROSPERO (CRD42020175268). STUDY SELECTION Articles were included if: 1) design was randomized or cohort, 2) adult population evaluated, 3) employed recommendations from greater than or equal to two PAD/PADIS domains, and 4) evaluated greater than or equal to 1 of the following outcome(s): short-term mortality, delirium occurrence, mechanical ventilation (MV) duration, or ICU length of stay (LOS). DATA EXTRACTION Two authors independently reviewed articles for eligibility, number of PAD/PADIS domains, quality according to National Heart, Lung, and Blood Institute assessment tools, implementation strategy use (including Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment [ABCDEF] bundle) by Cochrane Effective Practice and Organization of Care (EPOC) category, and clinical outcomes. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. DATA SYNTHESIS Among the 25 of 243 (10.3%) full-text articles included ( n = 23,215 patients), risk of bias was high in 13 (52%). Most studies were cohort ( n = 22, 88%). A median of 5 (interquartile range [IQR] 4-7) EPOC strategies were used to implement recommendations from two (IQR 2-3) PAD/PADIS domains. Cohort and randomized studies were pooled separately. In the cohort studies, use of EPOC strategies was not associated with a change in mortality (risk ratio [RR] 1.01; 95% CI, 0.9-1.12), or delirium (RR 0.92; 95% CI, 0.82-1.03), but was associated with a reduction in MV duration (weighted mean difference [WMD] -0.84 d; 95% CI, -1.25 to -0.43) and ICU LOS (WMD -0.77 d; 95% CI, -1.51 to 0.04). For randomized studies, EPOC strategy use was associated with reduced mortality and MV duration but not delirium or ICU LOS. CONCLUSIONS Using multiple implementation strategies to adopt PAD/PADIS guideline recommendations may reduce mortality, duration of MV, and ICU LOS. Further prospective, controlled studies are needed to identify the most effective strategies to implement PAD/PADIS recommendations.
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Affiliation(s)
- Nicole E Hume
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Isabelle Zerfas
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI
| | - Adrian Wong
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Pamela L Smithburger
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
- Department of Pharmacy and Therapeutics, UPMC, Pittsburgh, PA
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ
| | - John W Devlin
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Pharmacy and Therapeutics, School of Pharmacy, Northeastern University, Boston, MA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
- Department of Pharmacy and Therapeutics, UPMC, Pittsburgh, PA
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Nadim MK, Kellum JA, Forni L, Francoz C, Asrani SK, Ostermann M, Allegretti AS, Neyra JA, Olson JC, Piano S, VanWagner LB, Verna EC, Akcan-Arikan A, Angeli P, Belcher JM, Biggins SW, Deep A, Garcia-Tsao G, Genyk YS, Gines P, Kamath PS, Kane-Gill SL, Kaushik M, Lumlertgul N, Macedo E, Maiwall R, Marciano S, Pichler RH, Ronco C, Tandon P, Velez JCQ, Mehta RL, Durand F. Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting. J Hepatol 2024:S0168-8278(24)00214-9. [PMID: 38527522 DOI: 10.1016/j.jhep.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
Patients with cirrhosis are prone to developing acute kidney injury (AKI), a complication associated with a markedly increased in-hospital morbidity and mortality, along with a risk of progression to chronic kidney disease. Whereas patients with cirrhosis are at increased risk of developing any phenotype of AKI, hepatorenal syndrome (HRS), a specific form of AKI (HRS-AKI) in patients with advanced cirrhosis and ascites, carries an especially high mortality risk. Early recognition of HRS-AKI is crucial since administration of splanchnic vasoconstrictors may reverse the AKI and serve as a bridge to liver transplantation, the only curative option. In 2023, a joint meeting of the International Club of Ascites (ICA) and the Acute Disease Quality Initiative (ADQI) was convened to develop new diagnostic criteria for HRS-AKI, to provide graded recommendations for the work-up, management and post-discharge follow-up of patients with cirrhosis and AKI, and to highlight priorities for further research.
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Affiliation(s)
- Mitra K Nadim
- Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lui Forni
- School of Medicine, University of Surrey and Critical Care Unit, Royal Surrey Hospital Guildford UK
| | - Claire Francoz
- Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France
| | | | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, Department of Critical Care, London, UK
| | - Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jody C Olson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED, University and Hospital of Padova, Padova, Italy
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth C Verna
- Division of Digestive and Liver Diseases, Columbia University, New York, NY, USA
| | - Ayse Akcan-Arikan
- Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, TX, USA
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, University and Teaching Hospital of Padua, Italy
| | - Justin M Belcher
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Scott W Biggins
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akash Deep
- Pediatric Intensive Care Unit, King's College Hospital, London, UK
| | - Guadalupe Garcia-Tsao
- Digestive Diseases Section, Yale University School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Yuri S Genyk
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Abdominal Organ Transplantation at Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Pere Gines
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi-Sunyer and Ciber de Enfermedades Hepàticas y Digestivas, Barcelona, Catalonia, Spain
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Nuttha Lumlertgul
- Excellence Centre in Critical Care Nephrology and Division of Nephrology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Etienne Macedo
- Division of Nephrology, Department of Medicine, University of California San Diego, CA, USA
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Raimund H Pichler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza-Italy
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Juan-Carlos Q Velez
- Department of Nephrology, Ochsner Health, New Orleans, LA, USA; Ochsner Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Ravindra L Mehta
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - François Durand
- Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, France; University Paris Cité, Paris, France.
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Peasah SK, Swart ECS, Huang Y, Kane-Gill SL, Seybert AL, Patel U, Manolis C, Good CB. Disease-Modifying Medications in Patients with Rheumatoid Arthritis in the USA: Trends from 2016 to 2021. Drugs Real World Outcomes 2024:10.1007/s40801-024-00416-3. [PMID: 38368583 DOI: 10.1007/s40801-024-00416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Disease-modifying anti-rheumatic drugs (DMARDs), since their introduction in 1990, have revolutionized the management of rheumatoid arthritis. Newer DMARDs have recently been approved, influencing treatment patterns and clinical guidelines. OBJECTIVE To update the current prescribing patterns of DMARDs in the pharmacotherapy of rheumatoid arthritis (RA) to include the pandemic era. METHODS This was a retrospective cross-sectional multi-year study. Using Optum's Clinformatics® Data Mart Database, we summarized trends in the prevalence of DMARD use in the USA from 2016 to 2021 by year for adult patients ≥ 18 years old with at least one medical RA claim and one pharmacy/medical claim of a DMARD medication. Trends included type of DMARD, class of DMARD (conventional (csDMARDs), biologics [tumor necrosis factor (TNFi) and Non-TNFi), and Janus kinase inhibitors (JAKs)], and triple therapy [methotrexate (MTX), hydroxychloroquine (HCQ), sulfasalazine (SUL)] used. RESULTS The total sample from 2016 to 2021 was 670,679 commercially insured patients. The average age was 63.7 years (SD 13.6), and 76.7% were female and 70% were White. csDMARDs remain the most prescribed (ranging from 77.2 to 79.2%). Although JAKs were the least prescribed DMARD class, their proportion more than doubled from 2016 (1.5%) to 2021 (4%). MTX utilization declined from 40% in 2016 to 34% in 2021. In contrast, HCQ use increased during the pandemic era from < 25% in 2018 to 30% in 2021. Although there is evidence of the therapeutic benefit of triple therapy, its use was very low (~ 1%) compared to biologics only (~ 17%) or biologics+MTX (~ 10%). CONCLUSION About half of patients with RA were on DMARDs. As expected, csDMARDs were highly used consistently. The COVID-19 pandemic might have influenced the use of HCQ and infusion DMARDs. Triple therapy use remains low.
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Affiliation(s)
- Samuel K Peasah
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA.
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Elizabeth C S Swart
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA
| | - Yan Huang
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA
| | | | - Amy L Seybert
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Urvashi Patel
- Evernorth Research Institute, Cigna Health, St. Louis, MO, USA
| | - Chronis Manolis
- Department of Pharmacy, UPMC Health Plan, Pittsburgh, PA, USA
| | - Chester B Good
- Value-based Pharmacy Initiatives, Center for High-Value Health Care, UPMC Health Plan, US Steel Tower, 40th Floor. 600 Grant Street, Pittsburgh, PA, 15219, USA
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacy, UPMC Health Plan, Pittsburgh, PA, USA
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Karimzadeh I, Strader M, Kane-Gill SL, Murray PT. Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights. Curr Opin Crit Care 2023; 29:595-606. [PMID: 37861206 DOI: 10.1097/mcc.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Drug associated kidney injury (D-AKI) occurs in 19-26% of hospitalized patients and ranks as the third to fifth leading cause of acute kidney injury (AKI) in the intensive care unit (ICU). Given the high use of antimicrobials in the ICU and the emergence of new resistant organisms, the implementation of preventive measures to reduce the incidence of D-AKI has become increasingly important. RECENT FINDINGS Artificial intelligence is showcasing its capabilities in early recognition of at-risk patients for acquiring AKI. Furthermore, novel synthetic medications and formulations have demonstrated reduced nephrotoxicity compared to their traditional counterparts in animal models and/or limited clinical evaluations, offering promise in the prevention of D-AKI. Nephroprotective antioxidant agents have had limited translation from animal studies to clinical practice. The control of modifiable risk factors remains pivotal in avoiding D-AKI. SUMMARY The use of both old and new antimicrobials is increasingly important in combating the rise of resistant organisms. Advances in technology, such as artificial intelligence, and alternative formulations of traditional antimicrobials offer promise in reducing the incidence of D-AKI, while antioxidant medications may aid in minimizing nephrotoxicity. However, maintaining haemodynamic stability using isotonic fluids, drug monitoring, and reducing nephrotoxic burden combined with vigilant antimicrobial stewardship remain the core preventive measures for mitigating D-AKI while optimizing effective antimicrobial therapy.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Michael Strader
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
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9
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Kashani KB, Awdishu L, Bagshaw SM, Barreto EF, Claure-Del Granado R, Evans BJ, Forni LG, Ghosh E, Goldstein SL, Kane-Gill SL, Koola J, Koyner JL, Liu M, Murugan R, Nadkarni GN, Neyra JA, Ninan J, Ostermann M, Pannu N, Rashidi P, Ronco C, Rosner MH, Selby NM, Shickel B, Singh K, Soranno DE, Sutherland SM, Bihorac A, Mehta RL. Digital health and acute kidney injury: consensus report of the 27th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol 2023; 19:807-818. [PMID: 37580570 DOI: 10.1038/s41581-023-00744-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/16/2023]
Abstract
Acute kidney injury (AKI), which is a common complication of acute illnesses, affects the health of individuals in community, acute care and post-acute care settings. Although the recognition, prevention and management of AKI has advanced over the past decades, its incidence and related morbidity, mortality and health care burden remain overwhelming. The rapid growth of digital technologies has provided a new platform to improve patient care, and reports show demonstrable benefits in care processes and, in some instances, in patient outcomes. However, despite great progress, the potential benefits of using digital technology to manage AKI has not yet been fully explored or implemented in clinical practice. Digital health studies in AKI have shown variable evidence of benefits, and the digital divide means that access to digital technologies is not equitable. Upstream research and development costs, limited stakeholder participation and acceptance, and poor scalability of digital health solutions have hindered their widespread implementation and use. Here, we provide recommendations from the Acute Disease Quality Initiative consensus meeting, which involved experts in adult and paediatric nephrology, critical care, pharmacy and data science, at which the use of digital health for risk prediction, prevention, identification and management of AKI and its consequences was discussed.
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Affiliation(s)
- Kianoush B Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Linda Awdishu
- Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | | | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2 - CNS, Cochabamba, Bolivia
- Universidad Mayor de San Simon, School of Medicine, Cochabamba, Bolivia
| | - Barbara J Evans
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital NHS Foundation Trust & Department of Clinical & Experimental Medicine, University of Surrey, Guildford, UK
| | - Erina Ghosh
- Philips Research North America, Cambridge, MA, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sandra L Kane-Gill
- Biomedical Informatics and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jejo Koola
- UC San Diego Health Department of Biomedical Informatics, Department of Medicine, La Jolla, CA, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mei Liu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Raghavan Murugan
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- The Clinical Research, Investigation, and Systems Modelling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Girish N Nadkarni
- Division of Data-Driven and Digital Medicine (D3M), Department of Medicine, Icahn School of Medicine at Mount Sinai; Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacob Ninan
- Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Neesh Pannu
- Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Parisa Rashidi
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Claudio Ronco
- Università di Padova; Scientific Director Foundation IRRIV; International Renal Research Institute; San Bortolo Hospital, Vicenza, Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit of Translational Medical Sciences, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | - Benjamin Shickel
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Karandeep Singh
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Danielle E Soranno
- Section of Nephrology, Department of Pediatrics, Indiana University, Riley Hospital for Children, Indianapolis, IN, USA
| | - Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Azra Bihorac
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA.
| | - Ravindra L Mehta
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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10
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Karimzadeh I, Barreto EF, Kellum JA, Awdishu L, Murray PT, Ostermann M, Bihorac A, Mehta RL, Goldstein SL, Kashani KB, Kane-Gill SL. Moving toward a contemporary classification of drug-induced kidney disease. Crit Care 2023; 27:435. [PMID: 37946280 PMCID: PMC10633929 DOI: 10.1186/s13054-023-04720-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
Drug-induced kidney disease (DIKD) accounts for about one-fourth of all cases of acute kidney injury (AKI) in hospitalized patients, especially in critically ill setting. There is no standard definition or classification system of DIKD. To address this, a phenotype definition of DIKD using expert consensus was introduced in 2015. Recently, a novel framework for DIKD classification was proposed that incorporated functional change and tissue damage biomarkers. Medications were stratified into four categories, including "dysfunction without damage," "damage without dysfunction," "both dysfunction and damage," and "neither dysfunction nor damage" using this novel framework along with predominant mechanism(s) of nephrotoxicity for drugs and drug classes. Here, we briefly describe mechanisms and provide examples of drugs/drug classes related to the categories in the proposed framework. In addition, the possible movement of a patient's kidney disease between certain categories in specific conditions is considered. Finally, opportunities and barriers to adoption of this framework for DIKD classification in real clinical practice are discussed. This new classification system allows congruencies for DIKD with the proposed categorization of AKI, offering clarity as well as consistency for clinicians and researchers.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Linda Awdishu
- Division of Clinical Pharmacy, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA, USA
| | | | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's and St Thomas' Hospital, London, UK
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA
- Intelligent Critical Care Center, University of Florida, Gainesville, FL, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandra L Kane-Gill
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- 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, Department of Biomedical Informatics, School of Medicine and the Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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11
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Newman TV, Yang J, Suh K, Jonassaint CR, Kane-Gill SL, Novelli EM. Use of Disease-Modifying Treatments in Patients With Sickle Cell Disease. JAMA Netw Open 2023; 6:e2344546. [PMID: 37991760 PMCID: PMC10665975 DOI: 10.1001/jamanetworkopen.2023.44546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Despite hydroxyurea being an established treatment for sickle cell disease (SCD), it remains underused. The recent approval of the disease-modifying treatments (DMTs) l-glutamine, crizanlizumab, and voxelotor underscores the need to understand the uptake of DMTs in the current treatment landscape. Objective To explore characteristics that may be associated with DMT use and to describe observed patterns of yearly DMT use from 2014 to 2021. Design, Setting, and Participants This cross-sectional study used administrative claims data from Optum's deidentified Clinformatics Data Mart Database from January 1, 2014, to September 30, 2021, to identify adults and children with SCD. Data were analyzed from August 1, 2022, to August 28, 2023. Exposure Use of DMTs. Main Outcomes and Measures Patient characteristics across groups with varying patterns of DMT use and yearly patterns of prescription fills for hydroxyurea, crizanlizumab, voxelotor, and l-glutamine. Results A total of 5022 beneficiaries with SCD (2081 [41.4%] aged 18-45 years; 2929 [58.3%] female) were included in sample A (144 [2.9%] inconsistent users, 274 [5.5%] incident users, 892 [17.8%] consistent users, and 3712 [73.9%] non-DMT users). Inconsistent users had a higher prevalence of vaso-occlusive crises (mean [SD], 3.7 [4.7]), splenic complications (6 of 144 [4.2%]), pulmonary complications (36 of 144 [25.0%]), kidney disease (21 of 144 [14.6%]), acute chest syndrome (18 of 144 [12.5%]), and health care visits (eg, mean [SD] inpatient visits, 7.0 [10.7]) compared with the other use groups. Non-DMT users had the lowest prevalence of vaso-occlusive crises (mean [SD], 0.8 [2.4]), acute chest syndrome (109 of 3712 [2.9%]), and inpatient (mean [SD], 2.0 [6.6]) and emergency department (mean [SD], 0.7 [3.1]) visits and the highest proportion of adults 65 years and older (593 of 3712 [16.0%]). In sample B (6387 beneficiaries with SCD), hydroxyurea use modestly increased from 428 of 2188 participants (19.6%) in 2014 to 701 of 2880 (24.3%) in 2021. Use of l-glutamine increased briefly but gradually decreased throughout the study period. In 2021, out of 2880 participants, 102 (3.5%) had at least 1 fill for crizanlizumab and 131 (4.6%) had at least 1 fill for voxelotor. Overall, total DMT use increased from 428 of 2188 participants (19.6%) in 2014 to 815 of 2880 patients (28.3%) in 2021. Conclusions and Relevance In this cross-sectional analysis of adults and children with SCD, uptake of DMTs remained low from 2014 to 2021, despite the approval of newer therapies. Notable differences in patient characteristics across varied DMT exposure types necessitate further exploration into factors that facilitate DMT use and the creation of strategies to enhance DMT uptake.
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Affiliation(s)
- Terri Victoria Newman
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jingye Yang
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kangho Suh
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Enrico M. Novelli
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Morin C, Padki A, Wong A, Miano T, Kane-Gill SL, Cozzi G, Deveau R. Comparison of COVID-19 Preprint and Peer-Reviewed Versions of Studies on Therapies for Critically Ill Patients. J Intensive Care Med 2023; 38:1060-1067. [PMID: 37337731 PMCID: PMC10285362 DOI: 10.1177/08850666231182563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Significant increases in the volume of preprint articles due to the COVID-19 pandemic, we examined the reliability of preprint articles compared to their peer-reviewed publications. MATERIALS AND METHODS Preprint articles evaluating experimental studies of select treatment options (anticoagulation, dexamethasone, hydroxychloroquine, remdesivir, and tocilizumab) for COVID-19 in the critically ill, available in a peer-reviewed publication were screened for inclusion within Altmetric (n = 2040). A total of 40 articles met inclusion criteria, with 21 being randomly selected for evaluation. The primary outcome of this evaluation was a change in a study's reported primary outcome or statistical significance between preprint and peer-reviewed articles. Secondary outcomes included changes in primary/secondary outcome effect size and change in study conclusion. RESULTS One article (4.8%, 95% CI 0.12%-23.8%) had a change in the primary outcome. Seven articles (33.3%, 95% CI 14.6%-57.0%) had a change in the primary outcome's effect measure. Five studies (23.8%, 95% CI 8.2%-47.2%) had changes in statistical significance of at least one secondary outcome. Four studies (19.0%, 95% CI 5.4%-41.9%) had a change in study conclusion. CONCLUSIONS In preprint articles of COVID-19 treatments, the provided primary outcome is generally reliable, while interpretation of secondary outcomes should be made with caution, while awaiting completion of the peer-review process.
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Affiliation(s)
- Conor Morin
- Department of Pharmacy, Providence Alaska Medical Center, Anchorage, AK, USA
| | - Anirudh Padki
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Adrian Wong
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Todd Miano
- Department of Biostatistics, Epidemiology and Statistics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacy, UPMC Presbyterian, Pittsburgh, PA, USA
| | - Gabrielle Cozzi
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert Deveau
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
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13
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Gray MP, Dhavalikar N, Boyce RD, Kane-Gill SL. Qualitative analysis of healthcare provider perspectives to evaluating beta-lactam allergies. J Hosp Infect 2023; 141:198-208. [PMID: 37574018 DOI: 10.1016/j.jhin.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is a lack of understanding of the barriers reported by healthcare providers when evaluating beta-lactam allergies, but knowledge of these barriers is required for practical and effective implementation interventions. METHODS Twenty-five healthcare providers, consisting of physicians, nurses and pharmacists practicing in the areas of intensive care, emergency medicine, infectious disease and general hospital practice, were interviewed between September 2021 and July 2023. Twenty-three of these providers were practising in the USA. A semi-structured interview guide grounded in the Theoretical Domain Framework was used for the interviews. Deductive and inductive analysis was performed on the interview transcripts, and translated into intervention recommendations using the Behaviour Change Wheel. RESULTS Widely held beliefs included a lack of clear policy for the evaluation of allergies, confusing or missing documentation of allergy information, confidence in their own and their colleagues' ability to evaluate allergies when information is available, and pharmacists as the provider most equipped to evaluate beta-lactam allergies. CONCLUSIONS Health systems should adopt and disseminate policies for the evaluation of beta-lactam allergies, and promote the use of pharmacists in the evaluation of drug allergies when possible. Allergy sections of electronic health records should be reworked to encourage unambiguous documentation of allergy reactions and support using previously tolerated beta-lactam antibiotics.
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Affiliation(s)
- M P Gray
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
| | - N Dhavalikar
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - R D Boyce
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - S L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
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14
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Nunnally ME, Dager WE, Patel H, Al-Hazzani W, Nadkarni VM, Kane-Gill SL. Revising the Process and Structure of the Society of Critical Care Medicine Guidelines Toward a Living Guideline Model. Crit Care Med 2023; 51:1281-1284. [PMID: 37707376 DOI: 10.1097/ccm.0000000000005938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Mark E Nunnally
- Departments of Anesthesiology, Perioperative Care & Pain Medicine, Neurology, Surgery and Medicine, NYU Grossman School of Medicine, New York, NY
| | - William E Dager
- University of California, Davis Medical Center, Sacramento, CA
| | - Hariyali Patel
- Department of Quality and Research, Society of Critical Care Medicine, Mount Prospect, IL
| | | | - Vinay M Nadkarni
- Departments of Anesthesiology, Critical Care, and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
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15
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Adiyeke E, Ren Y, Ruppert MM, Shickel B, Kane-Gill SL, Murugan R, Rashidi P, Bihorac A, Ozrazgat-Baslanti T. A deep learning-based dynamic model for predicting acute kidney injury risk severity in postoperative patients. Surgery 2023; 174:709-714. [PMID: 37316372 PMCID: PMC10683578 DOI: 10.1016/j.surg.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/17/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Acute kidney injury is a common postoperative complication affecting between 10% and 30% of surgical patients. Acute kidney injury is associated with increased resource usage and chronic kidney disease development, with more severe acute kidney injury suggesting more aggressive deterioration in clinical outcomes and mortality. METHODS We considered 42,906 surgical patients admitted to University of Florida Health (n = 51,806) between 2014 and 2021. Acute kidney injury stages were determined using the Kidney Disease Improving Global Outcomes serum creatinine criteria. We developed a recurrent neural network-based model to continuously predict acute kidney injury risk and state in the following 24 hours and compared it with logistic regression, random forest, and multi-layer perceptron models. We used medications, laboratory and vital measurements, and derived features from past one-year records as inputs. We analyzed the proposed model with integrated gradients for enhanced explainability. RESULTS Postoperative acute kidney injury at any stage developed in 20% (10,664) of the cohort. The recurrent neural network model was more accurate in predicting nearly all categories of next-day acute kidney injury stages (including the no acute kidney injury group). The area under the receiver operating curve and 95% confidence intervals for recurrent neural network and logistic regression models were for no acute kidney injury (0.98 [0.98-0.98] vs 0.93 [0.93-0.93]), stage 1 (0.95 [0.95-0.95] vs. 0.81 [0.80-0.82]), stage 2/3 (0.99 [0.99-0.99] vs 0.96 [0.96-0.97]), and stage 3 with renal replacement therapy (1.0 [1.0-1.0] vs 1.0 [1.0-1.0]. CONCLUSION The proposed model demonstrates that temporal processing of patient information can lead to more granular and dynamic modeling of acute kidney injury status and result in more continuous and accurate acute kidney injury prediction. We showcase the integrated gradients framework's utility as a mechanism for enhancing model explainability, potentially facilitating clinical trust for future implementation.
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Affiliation(s)
- Esra Adiyeke
- University of Florida Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL
| | - Yuanfang Ren
- University of Florida Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL
| | - Matthew M Ruppert
- University of Florida Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL
| | - Benjamin Shickel
- University of Florida Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL. http://www.twitter.com/BenjaminShickel
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Raghavan Murugan
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Parisa Rashidi
- University of Florida Intelligent Critical Care Center, Gainesville, FL; Department of Biomedical Engineering, University of Florida, Gainesville, FL. http://www.twitter.com/Parisa__Rashidi
| | - Azra Bihorac
- University of Florida Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL.
| | - Tezcan Ozrazgat-Baslanti
- University of Florida Intelligent Critical Care Center, Gainesville, FL; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL. http://www.twitter.com/TBaslanti
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16
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Wong A, Berenbrok LA, Snader L, Soh YH, Kumar VK, Javed MA, Bates DW, Sorce LR, Kane-Gill SL. Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach. Crit Care Explor 2023; 5:e0967. [PMID: 37644969 PMCID: PMC10461946 DOI: 10.1097/cce.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Clinical decision support systems (CDSSs) are used in various aspects of healthcare to improve clinical decision-making, including in the ICU. However, there is growing evidence that CDSS are not used to their full potential, often resulting in alert fatigue which has been associated with patient harm. Clinicians in the ICU may be more vulnerable to desensitization of alerts than clinicians in less urgent parts of the hospital. We evaluated facilitators and barriers to appropriate CDSS interaction and provide methods to improve currently available CDSS in the ICU. DESIGN Sequential explanatory mixed-methods study design, using the BEhavior and Acceptance fRamework. SETTING International survey study. PATIENT/SUBJECTS Clinicians (pharmacists, physicians) identified via survey, with recent experience with clinical decision support. INTERVENTIONS An initial survey was developed to evaluate clinician perspectives on their interactions with CDSS. A subsequent in-depth interview was developed to further evaluate clinician (pharmacist, physician) beliefs and behaviors about CDSS. These interviews were then qualitatively analyzed to determine themes of facilitators and barriers with CDSS interactions. MEASUREMENTS AND MAIN RESULTS A total of 48 respondents completed the initial survey (estimated response rate 15.5%). The majority believed that responding to CDSS alerts was part of their job (75%) but felt they experienced alert fatigue (56.5%). In the qualitative analysis, a total of five facilitators (patient safety, ease of response, specificity, prioritization, and feedback) and four barriers (excess quantity, work environment, difficulty in response, and irrelevance) were identified from the in-depth interviews. CONCLUSIONS In this mixed-methods survey, we identified areas that institutions should focus on to improve appropriate clinician interactions with CDSS, specific to the ICU. Tailoring of CDSS to the ICU may lead to improvement in CDSS and subsequent improved patient safety outcomes.
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Affiliation(s)
- Adrian Wong
- Beth Israel Deaconess Medical Center, Department of Pharmacy, Boston, MA
| | | | - Lauren Snader
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA
| | - Yu Hyeon Soh
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA
| | | | | | - David W Bates
- Brigham and Women's Hospital, Division of General Internal Medicine and Primary Care, Boston, MA
- Harvard Medical School, School of Medicine, Boston, MA
| | - Lauren R Sorce
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Northwestern University Feinberg School of Medicine, Division of Pediatric Critical Care, Chicago, IL
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Yoo YJ, Wilkins KJ, Alakwaa F, Liu F, Torre-Healy LA, Krichevsky S, Hong SS, Sakhuja A, Potu CK, Saltz JH, Saran R, Zhu RL, Setoguchi S, Kane-Gill SL, Mallipattu SK, He Y, Ellison DH, Byrd JB, Parikh CR, Moffitt RA, Koraishy FM. Geographic and Temporal Trends in COVID-Associated Acute Kidney Injury in the National COVID Cohort Collaborative. Clin J Am Soc Nephrol 2023; 18:1006-1018. [PMID: 37131278 PMCID: PMC10564368 DOI: 10.2215/cjn.0000000000000192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND AKI is associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19); however, its incidence, geographic distribution, and temporal trends since the start of the pandemic are understudied. METHODS Electronic health record data were obtained from 53 health systems in the United States in the National COVID Cohort Collaborative. We selected hospitalized adults diagnosed with COVID-19 between March 6, 2020, and January 6, 2022. AKI was determined with serum creatinine and diagnosis codes. Time was divided into 16-week periods (P1-6) and geographical regions into Northeast, Midwest, South, and West. Multivariable models were used to analyze the risk factors for AKI or mortality. RESULTS Of a total cohort of 336,473, 129,176 (38%) patients had AKI. Fifty-six thousand three hundred and twenty-two (17%) lacked a diagnosis code but had AKI based on the change in serum creatinine. Similar to patients coded for AKI, these patients had higher mortality compared with those without AKI. The incidence of AKI was highest in P1 (47%; 23,097/48,947), lower in P2 (37%; 12,102/32,513), and relatively stable thereafter. Compared with the Midwest, the Northeast, South, and West had higher adjusted odds of AKI in P1. Subsequently, the South and West regions continued to have the highest relative AKI odds. In multivariable models, AKI defined by either serum creatinine or diagnostic code and the severity of AKI was associated with mortality. CONCLUSIONS The incidence and distribution of COVID-19-associated AKI changed since the first wave of the pandemic in the United States. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_08_08_CJN0000000000000192.mp3.
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Affiliation(s)
- Yun J Yoo
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Kenneth J Wilkins
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Fadhl Alakwaa
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Feifan Liu
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Luke A Torre-Healy
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Spencer Krichevsky
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Stephanie S Hong
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Ankit Sakhuja
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Chetan K Potu
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Joel H Saltz
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Rajiv Saran
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Richard L Zhu
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Soko Setoguchi
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Sandra L Kane-Gill
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Sandeep K Mallipattu
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Yongqun He
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - David H Ellison
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - James B Byrd
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Chirag R Parikh
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Richard A Moffitt
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Farrukh M Koraishy
- YJY: Department of Biology, Stony Brook University, Stony Brook, NY
- KJW: Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- FA: Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
- FL: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
- LATH: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SK: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- SSH: Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- AS: Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
- CKP: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
- JHS: Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
- RS: Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
- RLZ: Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
- SS: Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
- SLKG: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- SKM: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
- YH: Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
- DHE: Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
- JBB: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- CRP: Johns Hopkins School of Medicine, Baltimore, MD
- RAM: Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
- FMK: Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
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Stottlemyer BA, Abebe KZ, Palevsky PM, Fried L, Schulman IH, Parikh CR, Poggio E, Siew ED, Gutierrez OM, Horwitz E, Weir MR, Wilson FP, Kane-Gill SL. Expert Consensus on the Nephrotoxic Potential of 195 Medications in the Non-intensive Care Setting: A Modified Delphi Method. Drug Saf 2023; 46:677-687. [PMID: 37223847 PMCID: PMC10208182 DOI: 10.1007/s40264-023-01312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Nephrotoxin exposure is significantly associated with acute kidney injury (AKI) development. A standardized list of nephrotoxic medications to surveil and their perceived nephrotoxic potential (NxP) does not exist for non-critically ill patients. OBJECTIVE This study generated consensus on the nephrotoxic effect of 195 medications used in the non-intensive care setting. METHODS Potentially nephrotoxic medications were identified through a comprehensive literature search, and 29 participants with nephrology or pharmacist expertise were identified. The primary outcome was NxP by consensus. Participants rated each drug on a scale of 0-3 (not nephrotoxic to definite nephrotoxicity). Group consensus was met if ≥ 75% of responses were one single rating or a combination of two consecutive ratings. If ≥ 50% of responses indicated "unknown" or not used in the non-intensive care setting, the medication was removed for consideration. Medications not meeting consensus for a given round were included in the subsequent round(s). RESULTS A total of 191 medications were identified in the literature, with 4 medications added after the first round from participants' recommendations. NxP index rating consensus after three rounds was: 14 (7.2%) no NxP in almost all situations (rating 0); 62 (31.8%) unlikely/possibly nephrotoxic (rating 0.5); 21 (10.8%) possibly nephrotoxic (rating 1); 49 (25.1%) possibly/probably nephrotoxic (rating 1.5); 2 (1.0%) probably nephrotoxic (rating 2); 8 (4.1%) probably/definite nephrotoxic (rating 2.5); 0 (0.0%) definitely nephrotoxic (rating 3); and 39 (20.0%) medications were removed from consideration. CONCLUSIONS NxP index rating provides clinical consensus on perceived nephrotoxic medications in the non-intensive care setting and homogeneity for future clinical evaluations and research.
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Affiliation(s)
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul M Palevsky
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Linda Fried
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ivonne H Schulman
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emilio Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Tennessee Valley Health Systems (TVHS) Nashville Veterans Affairs Hospital, Nashville, TN, USA
| | - Orlando M Gutierrez
- Department of Medicine, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Stottlemyer BA, McDermott MC, Minogue MR, Gray MP, Boyce RD, Kane-Gill SL. Assessing adverse drug reaction reports for antidiabetic medications approved by the food and drug administration between 2012 and 2017: a pharmacovigilance study. Ther Adv Drug Saf 2023; 14:20420986231181334. [PMID: 37332887 PMCID: PMC10272667 DOI: 10.1177/20420986231181334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Objective Between 2012 and 2017, the U.S. Food and Drug Administration (FDA) approved 10 antidiabetic indicated therapies. Due to the limited literature on voluntarily reported safety outcomes for recently approved antidiabetic drugs, this study investigated adverse drug reactions (ADRs) reported in the FDA Adverse Event Reporting System (FAERS). Research Design and Methods A disproportionality analysis of spontaneously reported ADRs was conducted. FAERS reports from January 1, 2012 to March 31, 2022 were compiled, allowing a 5-year buffer following drug approval in 2017. Reporting odds ratios were calculated for the top 10 ADRs, comparing new diabetic agents to the other approved drugs in their therapeutic class. Results 127,525 reports were identified for newly approved antidiabetic medications listed as the primary suspect (PS). For sodium-glucose co-transporter-2 (SGLT-2) inhibitors, the odds of blood glucose increased, nausea, and dizziness being reported was greater for empagliflozin. Dapagliflozin was associated with greater reports of weight decreased. Canagliflozin was found to have a disproportionally higher number of reports for diabetic ketoacidosis, toe amputation, acute kidney injury, fungal infections, and osteomyelitis. Assessing glucagon-like peptide-1 (GLP-1) receptor agonists, dulaglutide and semaglutide were associated with greater reports of gastrointestinal adverse drug reactions. Exenatide was disproportionally associated with injection site reactions and pancreatic carcinoma reports. Conclusion Pharmacovigilance studies utilizing a large publicly available dataset allow an essential opportunity to evaluate the safety profile of antidiabetic drugs utilized in clinical practice. Additional research is needed to evaluate these reported safety concerns for recently approved antidiabetic medications to determine causality.
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Affiliation(s)
| | | | | | - Matthew P. Gray
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard D. Boyce
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Taneja SB, Callahan TJ, Paine MF, Kane-Gill SL, Kilicoglu H, Joachimiak MP, Boyce RD. Developing a Knowledge Graph for Pharmacokinetic Natural Product-Drug Interactions. J Biomed Inform 2023; 140:104341. [PMID: 36933632 PMCID: PMC10150409 DOI: 10.1016/j.jbi.2023.104341] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Pharmacokinetic natural product-drug interactions (NPDIs) occur when botanical or other natural products are co-consumed with pharmaceutical drugs. With the growing use of natural products, the risk for potential NPDIs and consequent adverse events has increased. Understanding mechanisms of NPDIs is key to preventing or minimizing adverse events. Although biomedical knowledge graphs (KGs) have been widely used for drug-drug interaction applications, computational investigation of NPDIs is novel. We constructed NP-KG as a first step toward computational discovery of plausible mechanistic explanations for pharmacokinetic NPDIs that can be used to guide scientific research. METHODS We developed a large-scale, heterogeneous KG with biomedical ontologies, linked data, and full texts of the scientific literature. To construct the KG, biomedical ontologies and drug databases were integrated with the Phenotype Knowledge Translator framework. The semantic relation extraction systems, SemRep and Integrated Network and Dynamic Reasoning Assembler, were used to extract semantic predications (subject-relation-object triples) from full texts of the scientific literature related to the exemplar natural products green tea and kratom. A literature-based graph constructed from the predications was integrated into the ontology-grounded KG to create NP-KG. NP-KG was evaluated with case studies of pharmacokinetic green tea- and kratom-drug interactions through KG path searches and meta-path discovery to determine congruent and contradictory information in NP-KG compared to ground truth data. We also conducted an error analysis to identify knowledge gaps and incorrect predications in the KG. RESULTS The fully integrated NP-KG consisted of 745,512 nodes and 7,249,576 edges. Evaluation of NP-KG resulted in congruent (38.98% for green tea, 50% for kratom), contradictory (15.25% for green tea, 21.43% for kratom), and both congruent and contradictory (15.25% for green tea, 21.43% for kratom) information compared to ground truth data. Potential pharmacokinetic mechanisms for several purported NPDIs, including the green tea-raloxifene, green tea-nadolol, kratom-midazolam, kratom-quetiapine, and kratom-venlafaxine interactions were congruent with the published literature. CONCLUSION NP-KG is the first KG to integrate biomedical ontologies with full texts of the scientific literature focused on natural products. We demonstrate the application of NP-KG to identify known pharmacokinetic interactions between natural products and pharmaceutical drugs mediated by drug metabolizing enzymes and transporters. Future work will incorporate context, contradiction analysis, and embedding-based methods to enrich NP-KG. NP-KG is publicly available at https://doi.org/10.5281/zenodo.6814507. The code for relation extraction, KG construction, and hypothesis generation is available at https://github.com/sanyabt/np-kg.
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Affiliation(s)
- Sanya B Taneja
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA 15206, USA.
| | - Tiffany J Callahan
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
| | - Mary F Paine
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | | | - Halil Kilicoglu
- School of Information Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Marcin P Joachimiak
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Richard D Boyce
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
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22
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Williams VL, Smithburger PL, Imhoff AN, Groetzinger LM, Culley CM, Burke CX, Murugan R, Lamberty PE, Mahmud M, Benedict NJ, Kellum JA, Kane-Gill SL. Interventions, Barriers, and Proposed Solutions Associated With the Implementation of a Protocol That Uses Clinical Decision Support and a Stress Biomarker Test to Identify ICU Patients at High-Risk for Drug Associated Acute Kidney Injury. Ann Pharmacother 2023; 57:408-415. [PMID: 35962583 DOI: 10.1177/10600280221117993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Damage biomarkers are helpful in early identification of patients who are at risk of developing acute kidney injury (AKI). Investigations are ongoing to identify the optimal role of stress/damage biomarkers in clinical practice regarding AKI risk prediction, surveillance, diagnosis, and prognosis. OBJECTIVE To determine the impact of utilizing a clinical decision support system (CDSS) to guide stress biomarker testing in intensive care unit (ICU) patients at risk for drug-induced acute kidney injury (D-AKI). METHODS A protocol was designed utilizing a clinical decision support system (CDSS) alert to identify patients that were ordered 3 or more potentially nephrotoxic medications, suggesting risk for progressing to AKI from nephrotoxic burden. Once alerted to these high-risk patients, the pharmacist determined if action was needed by ordering a stress biomarker test, tissue inhibitor of metalloproteinase-2-insulin-like growth factor-binding protein 7 (TIMP-2•IGFBP7). If the biomarker test result was elevated, the pharmacist provided nephrotoxin stewardship recommendations to the team. Pharmacists recorded the response to the clinical decision support alert, ordering, and interpreting the TIMP-2•IGFBP7, and information regarding clinical interventions. An alert in conjunction with TIMP-2•IGFBP7 as a strategy for AKI risk prediction and stimulant for patient care management was assessed. In addition, barriers and solutions to protocol implementation were evaluated. RESULTS There were 394 total activities recorded by pharmacists for 345 unique patients. Ninety-three (93/394; 23.6%) actionable alerts resulted in a TIMP-2•IGFBP7 test being ordered. Thirty-one TIMP-2•IGFBP7 results were >0.3 (31/81; 38.3%), suggesting a high-risk of progression to AKI, which prompted 191 pharmacist/team interventions. On average, there were 1.64 interventions per patient in the low-risk patients, 3.43 in high-risk patients, and 3.75 in the highest-risk patients. CONCLUSION AND RELEVANCE Stress biomarkers can be used in conjunction with CDSS alerts to affect therapeutic decisions in ICU patients at high-risk for D-AKI.
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Affiliation(s)
| | - Pamela L Smithburger
- UPMC Presbyterian, Pittsburgh, PA, USA.,University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | | | - Colleen M Culley
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | - Raghavan Murugan
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA.,Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phillip E Lamberty
- UPMC Presbyterian, Pittsburgh, PA, USA.,Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mujtaba Mahmud
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Neal J Benedict
- UPMC Presbyterian, Pittsburgh, PA, USA.,University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - John A Kellum
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA.,Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sandra L Kane-Gill
- UPMC Presbyterian, Pittsburgh, PA, USA.,University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.,Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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23
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Williams VL, Groetzinger LM, Smithburger PL, Imhoff A, Culley CM, Murugan R, Kellum JA, Kane-Gill SL. Case presentations of medication management for patients at risk for drug-associated acute kidney injury identified with a CDS system and a novel biomarker. Am J Health Syst Pharm 2023; 80:423-429. [PMID: 36308452 DOI: 10.1093/ajhp/zxac322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Traditional methods used to evaluate changes in kidney function to identify acute kidney injury (AKI) have significant limitations. Damage biomarkers can identify patients at risk for AKI prior to changes in kidney function. While clinical trials have shown that biomarker-guided treatment can improve outcomes, whether these biomarkers can influence providers' choice of treatment strategy for risk prediction, surveillance, or diagnostic evaluation in clinical practice is uncertain. SUMMARY This case series describes 4 patients at an academic medical center whose care was informed by kidney biomarker utilization in conjunction with a clinical decision support system (CDSS). Though each patient's clinical presentation was unique, kidney biomarkers were successfully employed as clinical tools in evaluating the risks and benefits of nephrotoxic medications. CONCLUSION This case series demonstrates 4 scenarios in which a kidney injury biomarker used in conjunction with CDSS and consideration of the patients' clinical presentation informed treatment strategies with the intent to prevent AKI.
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Affiliation(s)
| | | | - Pamela L Smithburger
- UPMC Presbyterian, Pittsburgh, PA, and University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | - Colleen M Culley
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Raghavan Murugan
- UPMC Presbyterian, Pittsburgh, PA, and Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sandra L Kane-Gill
- UPMC Presbyterian, Pittsburgh, PA, and University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
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24
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Li X, Ndungu P, Taneja SB, Chapin MR, Egbert SB, Akenapalli K, Paine MF, Kane-Gill SL, Boyce RD. An evaluation of adverse drug reactions and outcomes attributed to kratom in the US Food and Drug Administration Adverse Event Reporting System from January 2004 through September 2021. Clin Transl Sci 2023. [PMID: 36861661 DOI: 10.1111/cts.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/03/2023] Open
Abstract
Kratom is a widely used Asian botanical that has gained popularity in the United States due to a perception that it can treat pain, anxiety, and opioid withdrawal symptoms. The American Kratom Association estimates 10-16 million people use kratom. Kratom-associated adverse drug reactions (ADRs) continue to be reported and raise concerns about the safety profile of kratom. However, studies are lacking that describe the overall pattern of kratom-associated adverse events and quantify the association between kratom and adverse events. ADRs reported to the US Food and Drug Administration Adverse Event Reporting System from January 2004 through September 2021 were used to address these knowledge gaps. Descriptive analysis was conducted to analyze kratom-related adverse reactions. Conservative pharmacovigilance signals based on observed-to-expected ratios with shrinkage were estimated by comparing kratom to all other natural products and drugs. Based on 489 deduplicated kratom-related ADR reports, users were young (mean age 35.5 years), and more often male (67.5%) than female patients (23.5%). Cases were predominantly reported since 2018 (94.2%). Fifty-two disproportionate reporting signals in 17 system-organ-class categories were generated. The observed/reported number of kratom-related accidental death reports was 63-fold greater than expected. There were eight strong signals related to addiction or drug withdrawal. An excess proportion of ADR reports were about kratom-related drug complaints, toxicity to various agents, and seizures. Although further research is needed to assess the safety of kratom, clinicians and consumers should be aware that real-world evidence points to potential safety threats.
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Affiliation(s)
- Xiaotong Li
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick Ndungu
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sanya B Taneja
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maryann R Chapin
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan B Egbert
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Krishi Akenapalli
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary F Paine
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Sandra L Kane-Gill
- Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard D Boyce
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center of Excellence for Natural Product Drug Interaction Research, Spokane, Washington, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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25
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Yoo YJ, Wilkins KJ, Alakwaa F, Liu F, Torre-Healy LA, Krichevsky S, Hong SS, Sakhuja A, Potu CK, Saltz JH, Saran R, Zhu RL, Setoguchi S, Kane-Gill SL, Mallipattu SK, He Y, Ellison DH, Byrd JB, Parikh CR, Moffitt RA, Koraishy FM. COVID-19-associated AKI in hospitalized US patients: incidence, temporal trends, geographical distribution, risk factors and mortality. medRxiv 2022:2022.09.02.22279398. [PMID: 36093355 PMCID: PMC9460976 DOI: 10.1101/2022.09.02.22279398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Acute kidney injury (AKI) is associated with mortality in patients hospitalized with COVID-19, however, its incidence, geographic distribution, and temporal trends since the start of the pandemic are understudied. Methods Electronic health record data were obtained from 53 health systems in the United States (US) in the National COVID Cohort Collaborative (N3C). We selected hospitalized adults diagnosed with COVID-19 between March 6th, 2020, and January 6th, 2022. AKI was determined with serum creatinine (SCr) and diagnosis codes. Time were divided into 16-weeks (P1-6) periods and geographical regions into Northeast, Midwest, South, and West. Multivariable models were used to analyze the risk factors for AKI or mortality. Results Out of a total cohort of 306,061, 126,478 (41.0 %) patients had AKI. Among these, 17.9% lacked a diagnosis code but had AKI based on the change in SCr. Similar to patients coded for AKI, these patients had higher mortality compared to those without AKI. The incidence of AKI was highest in P1 (49.3%), reduced in P2 (40.6%), and relatively stable thereafter. Compared to the Midwest, the Northeast, South, and West had higher adjusted AKI incidence in P1, subsequently, the South and West regions continued to have the highest relative incidence. In multivariable models, AKI defined by either SCr or diagnostic code, and the severity of AKI was associated with mortality. Conclusions Uncoded cases of COVID-19-associated AKI are common and associated with mortality. The incidence and distribution of COVID-19-associated AKI have changed since the first wave of the pandemic in the US.
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Affiliation(s)
- Yun Jae Yoo
- Department of Biology, Stony Brook University, Stony Brook, NY
| | - Kenneth J. Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD
| | - Fadhl Alakwaa
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Luke A. Torre-Healy
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Spencer Krichevsky
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Stephanie S. Hong
- Biomedical Informatics and Data Science Section, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ankit Sakhuja
- Section of Cardiovascular Critical Care, Dept of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Chetan K. Potu
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Joel H. Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine and Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Richard L. Zhu
- Institution for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Soko Setoguchi
- Department of Medicine and Epidemiology, Rutgers Robert Wood Johnson Medical School and School of Public Health, New Brunswick, NJ
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
| | - Sandeep K. Mallipattu
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
| | - Yongqun He
- Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, and Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI
| | - David H. Ellison
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland OR and VA Portland Health Care System, Portland, OR
| | - James Brian Byrd
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Richard A. Moffitt
- Department of Biomedical Informatics, Cancer Center, Department of Pathology, Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY
| | - Farrukh M. Koraishy
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, and Northport VAMC, Northport, NY, USA
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26
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Côté JM, Kane-Gill SL, Murray PT. A ray of hope in the discord: is adding piperacillin-tazobactam to vancomycin truly more nephrotoxic? Intensive Care Med 2022; 48:1208-1210. [PMID: 36044050 DOI: 10.1007/s00134-022-06861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jean-Maxime Côté
- Division of Nephrology, Department of Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, Canada
- Clinical Research Center (CrCHUM), Centre Hospitalier de L'Université de Montréal, Montréal, Canada
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA
- Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick T Murray
- School of Medicine, University College Dublin, Dublin, Ireland.
- Division of Nephrology, Mater Misericordiae University Hospital, Dublin, Ireland.
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27
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Desai RJ, Kazarov CL, Wong A, Kane-Gill SL. Kidney Damage and Stress Biomarkers for Early Identification of Drug-Induced Kidney Injury: A Systematic Review. Drug Saf 2022; 45:839-852. [PMID: 35831683 DOI: 10.1007/s40264-022-01202-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) resulting from nephrotoxic medication use is prominent in hospitalized patients and is attributable to overall increases in mortality and costs of care. Serum creatinine (SCr), the current standard for identifying drug-induced AKI (DIAKI) is often delayed in its response to kidney insult by 26-36 h. OBJECTIVE This systematic review seeks to evaluate the clinical utility of several novel kidney damage and stress biomarkers for the prediction/timely detection of DIAKI, in comparison with traditional methods. METHODS A systematic review of the CINAHL, Cochrane Library, Embase, and PubMed databases was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, for articles analyzing the use of β2-microglobulin (B2M), interleukin (IL)-18, kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), and tissue inhibitor of metalloproteinase-2 * insulin-like growth factor-binding protein 7 [TIMP-1]*[IGFBP-7], for identifying DIAKI. Primary outcomes included time to DIAKI diagnosis using traditional methods and the time to significant difference in biomarker concentrations between DIAKI and non-AKI study subjects. Secondary outcomes included biomarker concentrations at the time of significant difference between the AKI status groups. RESULTS Fifteen unique articles were identified from the literature search. Twelve studies consisted of strictly hospitalized patient populations and three studies included hospitalized patients and patients discharged to home treatment. No studies reported values for urine volume output. Seventy-three percent of studies reported earlier times to significant difference of novel biomarker concentrations between the AKI and non-AKI groups than diagnosis of DIAKI by SCr alone. Significant variation was observed for individual urine biomarker concentrations at time of significant difference between the AKI status groups. CONCLUSIONS All analyzed biomarkers showed potential for use as early clinical markers of DIAKI, however further consensus on threshold urine concentrations for DIAKI is needed for meaningful implementation of these biomarkers in clinical practice.
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Affiliation(s)
- Ravi J Desai
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
| | | | - Adrian Wong
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Sandra L Kane-Gill
- University of Pittsburgh, School of Pharmacy, 6462 Salk Hall, 3507 Terrace St, Pittsburgh, PA, 15261, USA.
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28
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Boyce RD, Kravchenko OV, Perera S, Karp JF, Kane-Gill SL, Reynolds CF, Albert SM, Handler SM. Falls prediction using the nursing home minimum dataset. J Am Med Inform Assoc 2022; 29:1497-1507. [PMID: 35818288 PMCID: PMC9382393 DOI: 10.1093/jamia/ocac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of the study was to develop and validate a model to predict the risk of experiencing a fall for nursing home residents utilizing data that are electronically available at the more than 15 000 facilities in the United States. MATERIALS AND METHODS The fall prediction model was built and tested using 2 extracts of data (2011 through 2013 and 2016 through 2018) from the Long-term Care Minimum Dataset (MDS) combined with drug data from 5 skilled nursing facilities. The model was created using a hybrid Classification and Regression Tree (CART)-logistic approach. RESULTS The combined dataset consisted of 3985 residents with mean age of 77 years and 64% female. The model's area under the ROC curve was 0.668 (95% confidence interval: 0.643-0.693) on the validation subsample of the merged data. DISCUSSION Inspection of the model showed that antidepressant medications have a significant protective association where the resident has a fall history prior to admission, requires assistance to balance while walking, and some functional range of motion impairment in the lower body; even if the patient exhibits behavioral issues, unstable behaviors, and/or are exposed to multiple psychotropic drugs. CONCLUSION The novel hybrid CART-logit algorithm is an advance over the 22 fall risk assessment tools previously evaluated in the nursing home setting because it has a better performance characteristic for the fall prediction window of ≤90 days and it is the only model designed to use features that are easily obtainable at nearly every facility in the United States.
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Affiliation(s)
- Richard D Boyce
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Olga V Kravchenko
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Aging Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Charles F Reynolds
- Aging Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven M Handler
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Aging Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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29
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Miller MJ, Kane-Gill SL. Pandemic stimulates a variety of telepharmacy applications: Considerations for implementation, sustainability, and future directions. Am J Health Syst Pharm 2022; 79:918-920. [PMID: 35381057 DOI: 10.1093/ajhp/zxac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Michael J Miller
- Mid-Atlantic Permanente Research Institute (MAPRI), Rockville, MD, USA
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, and Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Schreier DJ, Rule AD, Kashani KB, Mara KC, Kane-Gill SL, Lieske JC, Chamberlain AM, Barreto EF. Nephrotoxin Exposure in the 3 Years following Hospital Discharge Predicts Development or Worsening of Chronic Kidney Disease among Acute Kidney Injury Survivors. Am J Nephrol 2022; 53:273-281. [PMID: 35294951 PMCID: PMC9090945 DOI: 10.1159/000522139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Survivors of acute kidney injury (AKI) are at high risk of progression to chronic kidney disease (CKD), for which drugs may be a modifiable risk factor. METHODS We conducted a population-based cohort study of Olmsted County, MN residents who developed AKI while hospitalized between January 1, 2006, and December 31, 2014, using Rochester Epidemiology Project data. Adults with a hospitalization complicated by AKI who survived at least 90 days after AKI development were included. Medical records were queried for prescription of potentially nephrotoxic medications over the 3 years after discharge. The primary outcome was de novo or progressive CKD defined by either a new diagnosis code for CKD or ≥30% decline in estimated glomerular filtration rate from baseline. The composite of CKD, AKI readmission, or death was also evaluated. RESULTS Among 2,461 AKI survivors, 2,140 (87%) received a potentially nephrotoxic medication during the 3 years following discharge. When nephrotoxic medication use was analyzed in a time-dependent fashion, those actively prescribed at least one of these drugs experienced a significantly higher risk of de novo or progressive CKD (HR 1.38: 95% CI: 1.24, 1.54). Similarly, active potentially nephrotoxic medication use predicted a greater risk of the composite endpoint of CKD, AKI readmission, or death within 3 years of discharge (HR 1.41: 95% CI: 1.28, 1.56). CONCLUSION In this population-based cohort study, AKI survivors actively prescribed one or more potentially nephrotoxic medications were at significantly greater risk for de novo or progressive CKD. An opportunity exists to reassess nephrotoxin appropriateness following an AKI episode to improve patient outcomes.
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Affiliation(s)
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kristin C. Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Patel JJ, Volino LR, Cosler LE, Wang X, Kane-Gill SL, Toscani M, Barone JA. Opioid abuse risk among student pharmacists. J Opioid Manag 2022; 18:161-166. [PMID: 35476885 DOI: 10.5055/jom.2022.0706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To benchmark opioid abuse risk among student pharmacists attending three northeast pharmacy schools utilizing the opioid risk tool (ORT). DESIGN A cross-sectional, anonymous risk assessment questionnaire. SETTING Three pharmacy schools in the northeast United States. PARTICIPANTS Professional year 1 (P1) through professional year 3 (P3) student pharmacists. METHODS ORT was collected and scored by investigators and inputted into an electronic format for analysis. Students voluntarily participated, and 812 surveys were completed during one course meeting time and day at each school. RESULTS The majority of students were in the low-risk category (n = 581, 71.6 percent). Additionally, 137 (16.9 percent) patients were categorized as moderate risk and 94 (11.6 percent) as high risk. No statistically significant differences existed when comparing risk groups across the first through third professional year student pharmacist cohorts. There were no statistically significant differences in the proportion of risk groups among the three pharmacy cohorts between low-risk versus the high-risk groups. When comparing risk groups by gender, males were found to have a statistically significant higher proportion of being classified as moderate or high risk. CONCLUSIONS The results of this study demonstrate that there may be some student pharmacists with an increased risk for opioid abuse potential. There is potential need for education regarding opioid risk awareness and abuse prevention, which may serve as a call to action for professional school students and practitioners to understand baseline opioid abuse risk if they require chronic pain therapy.
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Affiliation(s)
- Jena J Patel
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey. ORCID: https://orcid.org/0000-0001-7169-8520
| | - Lucio R Volino
- Pharmacy Practice and Administration, Director of Assessment, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey; Clinical Pharmacist, Barnabas Health Retail Pharmacy, RWJBarnabas Health, Livingston, New Jersey
| | - Leon E Cosler
- Department of Health Outcomes and Administrative Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, New York
| | - Xuanqing Wang
- Class of 2021, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra L Kane-Gill
- Critical Care Medicine and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Toscani
- Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Joseph A Barone
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Switzer GE, Puttarajappa CM, Kane-Gill SL, Fried LF, Abebe KZ, Kellum JA, Jhamb M, Bruce JG, Kuniyil V, Conway PT, Knight R, Murphy J, Palevsky PM. Patient-Reported Experiences after Acute Kidney Injury across Multiple Health-Related Quality-of-Life Domains. Kidney360 2021; 3:426-434. [PMID: 35582179 PMCID: PMC9034810 DOI: 10.34067/kid.0002782021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/29/2021] [Indexed: 01/10/2023]
Abstract
Background Investigations of health-related quality of life (HRQoL) in AKI have been limited in number, size, and domains assessed. We surveyed AKI survivors to describe the range of HRQoL AKI-related experiences and examined potential differences in AKI effects by sex and age at AKI episode. Methods AKI survivors among American Association of Kidney Patients completed an anonymous online survey in September 2020. We assessed: (1) sociodemographic characteristics; (2) effects of AKI-physical, emotional, social; and (3) perceptions about interactions with health care providers using quantitative and qualitative items. Results Respondents were 124 adult AKI survivors. Eighty-four percent reported that the AKI episode was very/extremely impactful on physical/emotional health. Fifty-seven percent reported being very/extremely concerned about AKI effects on work, and 67% were concerned about AKI effects on family. Only 52% of respondents rated medical team communication as very/extremely good. Individuals aged 22-65 years at AKI episode were more likely than younger/older counterparts to rate the AKI episode as highly impactful overall (90% versus 63% younger and 75% older individuals; P=0.04), more impactful on family (78% versus 50% and 46%; P=0.008), and more impactful on work (74% versus 38% and 10%; P<0.001). Limitations of this work include convenience sampling, retrospective data collection, and unknown AKI severity. Conclusions These findings are a critical step forward in understanding the range of AKI experiences/consequences. Future research should incorporate more comprehensive HRQoL measures, and health care professionals should consider providing more information in their patient communication about AKI and follow-up.
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Affiliation(s)
- Galen E. Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Chethan M. Puttarajappa
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra L. Kane-Gill
- Department of Pharmacy, University of Pittsburgh Medical Center, School of Pharmacy, University of Pittsburgh, Pennsylvania
| | - Linda F. Fried
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania,Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania,Kidney Medicine Section Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John A. Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica G. Bruce
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidya Kuniyil
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul T. Conway
- Chair of Policy and Global Affairs and Immediate Past President of American Association of Kidney Patients
| | - Richard Knight
- Current President of American Association of Kidney Patients
| | - John Murphy
- McGowan Institute for Regenerative Medicine, and Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul M. Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Kidney Medicine Section Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania,Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Prakasam D, Wong AL, Smithburger PL, Buckley MS, Kane-Gill SL. Benefits of Patient/Caregiver Engagement in Adverse Drug Reaction Reporting Compared With Other Sources of Reporting in the Inpatient Setting: A Systematic Review. J Patient Saf 2021; 17:e765-e772. [PMID: 32555051 DOI: 10.1097/pts.0000000000000734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Clinicians learn from prior adverse events through pharmacovigilance allowing for improved medication safety in the medication use process; therefore, adverse drug reaction (ADR) reporting needs to be maximized. This systematic review was conducted to determine whether engaging patients/caregivers in ADR reporting during a patient's hospitalization provides further information about ADRs not obtained from traditional sources of reporting (i.e., voluntary reporting, medical record review). METHODS This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A literature search was conducted from January 2018 to June 2019 in PubMed, CINAHL, and Embase. Studies were included if they were (i) conducted in the inpatient setting, (ii) surveyed patients/caregivers, (iii) compared patient/caregiver reporting with another source of reporting, and (iv) evaluated ADRs. Studies completed in an outpatient setting or nursing home were excluded. RESULTS A total of 11 studies were included. Sources of ADR information from patient/caregiver were obtained through interviews, surveys, questionnaires, or open-ended responses. Patient reporting was compared with medical record reports (7 articles) and health care professional reporting (4 articles). Approximately 11% to 35% of ADRs reported from patients were not identified through voluntary reporting by health care professionals, and 5.6% to 66% of ADRs obtained from patient reporting were not provided in the medical record. CONCLUSIONS Patients/caregivers are important sources of safety information to improve system and practice of medication use that may not be recorded by other surveillance methods. Administrators and clinicians need to determine the best approach to integrate patients/caregivers into routine reporting for optimal engagement.
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Affiliation(s)
- Dhanuvarshini Prakasam
- From the Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Adrian L Wong
- Department of Pharmacy Practice, MCPHS University, Boston, Massachusetts
| | | | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, Arizona
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Buckley MS, Komerdelj IA, D'Alessio PA, Rangan P, Agarwal SK, Tinta NC, Martinez BK, Ziadat DS, Yerondopoulos MJ, Kobic E, Kane-Gill SL. Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study. J Crit Care 2021; 67:134-140. [PMID: 34768175 DOI: 10.1016/j.jcrc.2021.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to either cefepime or meropenem with vancomycin in the ICU. MATERIALS AND METHODS A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted. RESULTS A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10-2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18-2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality. CONCLUSION Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Ivan A Komerdelj
- Department of Pharmacy, Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Dr, Gilbert, AZ 85234, USA.
| | - Paul A D'Alessio
- Department of Pharmacy, Banner Baywood Medical Center, 6644 E. Baywood Ave., Mesa, AZ 85206, USA.
| | - Pooja Rangan
- Department of Medicine, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Sumit K Agarwal
- Department of Medicine, University of Arizona-College of Medicine Phoenix, 550 E Van Buren Street, Phoenix, AZ 85004, USA.
| | - Nicole C Tinta
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Brandon K Martinez
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Delia S Ziadat
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Melanie J Yerondopoulos
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Emir Kobic
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Barreto EF, Schreier DJ, May HP, Mara KC, Chamberlain AM, Kashani KB, Piche SL, Wi CI, Kane-Gill SL, Smith VT, Rule AD. Incidence of Serum Creatinine Monitoring and Outpatient Visit Follow-Up among Acute Kidney Injury Survivors after Discharge: A Population-Based Cohort Study. Am J Nephrol 2021; 52:817-826. [PMID: 34727542 PMCID: PMC8665070 DOI: 10.1159/000519375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) affects 20% of hospitalized patients and worsens outcomes. To limit complications, post-discharge follow-up and kidney function testing are advised. The objective of this study was to evaluate the frequency of follow-up after discharge among AKI survivors. METHODS This was a population-based cohort study of adult Olmsted County residents hospitalized with an episode of stage II or III AKI between 2006 and 2014. Those dismissed from the hospital on dialysis, hospice, or who died within 30 days after discharge were excluded. The frequency and predictors of follow-up, defined as an outpatient serum creatinine (SCr) level or an in-person healthcare visit after discharge were described. RESULTS In the 627 included AKI survivors, the 30-day cumulative incidence of a follow-up outpatient SCr was 80% (95% confidence interval [CI]: 76% and 83%), a healthcare visit was 82% (95% CI: 79 and 85%), or both was 70% (95% CI: 66 and 73%). At 90 days and 1 year after discharge, the cumulative incidences of meeting both follow-up criteria rose to 82 and 91%, respectively. Independent predictors of receiving both an outpatient SCr assessment and healthcare visit within 30 days included lower estimated glomerular filtration rate at discharge, higher comorbidity burden, longer length of hospitalization, and greater maximum AKI severity. Age, sex, race/ethnicity, education level, and socioeconomic status did not predict follow-up. CONCLUSIONS Among patients with moderate to severe AKI, 30% did not have follow-up with a SCr and healthcare visit in the 30-day post-discharge interval. Follow-up was associated with higher acuity of illness rather than demographic or socioeconomic factors.
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Affiliation(s)
| | | | | | - Kristin C. Mara
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Chung-Il Wi
- Pediatric Asthma Epidemiology Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Andrew D. Rule
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Kim H, Pfeiffer CM, Gray MP, Stottlemyer BA, Boyce RD, Kane-Gill SL. Assessing Adverse Drug Reactions Reported for New Respiratory Medications in the FDA Adverse Event Reporting System Database. Respir Care 2021; 66:1739-1745. [PMID: 34103383 PMCID: PMC9993551 DOI: 10.4187/respcare.08809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Between 2012 and 2017, 25 new medications or combination products were approved by the Food and Drug Administration (FDA) for use in treatment of chronic lower respiratory diseases (CLRDs). With limited data on post-marketing patient exposure to these drugs, their safety profiles remain unknown. This study aims to provide post-marketing surveillance of these medications. METHODS A list of new CLRD medications approved between 2012 and 2017 was generated through searches on Drugs.com (https://www.drugs.com), FDA.gov (https://www.fda.gov), and IBM Micromedex (https://www.micromedexsolutions.com/home/dispatch/ssl/true). Data describing adverse drug reactions (ADRs) were collected from the FDA Adverse Event Reporting System for analysis. Of the 25 identified medications, we selected 4 medications indicated for asthma or COPD with at least 500 reports. Only ADRs catalogued with these medications as the primary suspect were analyzed. Reporting odds ratios were calculated for the top 10 ADRs of each CLRD medication. RESULTS A total of 61,682 ADR reports were collected for newly approved CLRD medications (n = 27,190 older adults; n = 30,502 male). Reports of COPD medications (umeclidinium and umeclidinium/vilanterol) indicate that umeclidinium/vilanterol yielded a higher reporting odds ratio than umeclidinium alone for reports of pain. Fluticasone furoate/vilanterol had higher reporting odds ratios for cough, pain, and dizziness than budesonide/formoterol and fluticasone propionate/salmeterol. CONCLUSIONS Our findings suggest that the incidence of different adverse events experienced by patients in post-marketing reports resembles the incidence reported in pre-marketing clinical trials for COPD medications, except for fluticasone furoate/vilanterol, which has several differences.
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Affiliation(s)
- Hyunwoo Kim
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Colin M Pfeiffer
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew P Gray
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Richard D Boyce
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Kim KC, Tadrous M, Kane-Gill SL, Barbash IJ, Rothenberger S, Suda KJ. Changes in Purchases for Intensive Care Medicines During the COVID-19 Pandemic: A Global Time Series Study. Chest 2021; 160:2123-2134. [PMID: 34389295 PMCID: PMC8421073 DOI: 10.1016/j.chest.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Drug supply disruptions have increased during the COVID-19 pandemic, especially for medicines used in the intensive care unit (ICU). Despite reported shortages in wealthy countries, global analyses of ICU drug purchasing during COVID-19 are limited. RESEARCH QUESTION Has COVID-19 impacted global drug purchases of first, second- and third-choice agents used in intensive care? STUDY DESIGN AND METHODS We conducted a cross-sectional time series study in a global pharmacy sales dataset comprising approximately 60% of the world's population. We analyzed pandemic-related changes in units purchased per 1,000 population for 69 ICU agents. Interventional autoregressive integrated moving average (ARIMA) models tested for significant changes when the pandemic was declared (March 2020) and during its first stage from April to August 2020, globally and by development status. RESULTS Relative to 2019, ICU drug purchases increased by 23.6% (95% CI: 7.9-37.9%) in March 2020 (P-value<0.001), and then decreased by 10.3% (95% CI:-16.9 to -3.5%) from April to August (P-value=0.006). Purchases for second-choice medicines changed the most, especially in developing countries (e.g.: 45.8% increase in March 2020). Despite similar relative changes (P-value=0.88), absolute purchasing rates in developing nations remained low. The observed decrease from April to August 2020 was only significant in developed countries (-13.1%; 95% CI: -17.4 to -4.4%; P-value< 0.001). Country-level variation appeared unrelated to expected demand and healthcare infrastructure. INTERPRETATION Purchases for intensive care medicines increased globally in the month of the COVID-19 pandemic declaration, but prior to peak infection rates. These changes were most pronounced for second-choice agents, suggesting that inexpensive, generic medicines may be more easily purchased in anticipation of pandemic-related ICU surges. Nevertheless, disparities in access persisted. Trends appeared unrelated to expected demand, and decreased purchasing from April to August 2020 may suggest over-buying. National and international policies are needed to ensure equitable drug purchasing during future pandemics.
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Affiliation(s)
- Katherine Callaway Kim
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA; University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management Pittsburgh, PA, USA.
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto Toronto, ON, Canada; Women's College Research Institute Toronto, ON, Canada
| | | | - Ian J Barbash
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA; CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
| | - Scott Rothenberger
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA
| | - Katie J Suda
- University of Pittsburgh School of Medicine, Department of General Internal Medicine Pittsburgh, PA, USA; Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System Pittsburgh, PA, USA
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Pruskowski JA, Kane-Gill SL, Kavalieratos D, Wilson BK, Arnold RM, Handler SM. Feasibility of an Academic Detailing Intervention to Support Deprescribing in the Nursing Home. J Am Med Dir Assoc 2021; 22:2398-2400.e4. [PMID: 34324872 DOI: 10.1016/j.jamda.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Jennifer A Pruskowski
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA; Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | | | | | - Robert M Arnold
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Steven M Handler
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Kane-Gill SL, Barreto EF, Bihorac A, Kellum JA. Development of a Theory-Informed Behavior Change Intervention to Reduce Inappropriate Prescribing of Nephrotoxins and Renally Eliminated Drugs. Ann Pharmacother 2021; 55:1474-1485. [PMID: 33855858 DOI: 10.1177/10600280211009567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Goals of managing patients with acute kidney injury (AKI) are mitigating disease progression and ensuring safety while providing supportive care because no effective treatment exists. One strategy recommended in guidelines to meet these goals is optimizing medication management. Unfortunately, guideline implementation appears to be lacking as observed by the frequent occurrence of medication errors and adverse drug events. OBJECTIVE To address this performance gap in the care of hospitalized patients receiving nephrotoxins and renally eliminated drugs, we sought to provide a potential intervention based on theory-informed behavior change. METHODS Formative research with a qualitative analysis identifying what needs to change in patient care was completed by obtaining clinician opinion and expert opinion and reviewing the published literature. Frontline providers, including 8 physicians, 4 pharmacists, and a multiprofessional group of authors, provided insight into possible barriers to appropriate prescribing. Capability, Opportunity, Motivation and Behavior model and Theoretical Domain Framework were applied to characterize behavior change interventions and inform a potential implementation intervention for changing inappropriate prescribing behaviors. RESULTS Lack of knowledge about appropriate drug management in patients at risk for adverse outcomes was provided as a major barrier. Other reported barriers included a lack of: (1) tools to assist with drug management, (2) motivation to make changes, (3) routinization, and (4) an accountable clinician. CONCLUSIONS AND RELEVANCE Assigning a designated clinician to execute a stepwise, routine care process following the checklist provided is a recommended intervention to overcome barriers. The intended impact is behavior change that reduces inappropriate prescribing.
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Affiliation(s)
- Sandra L Kane-Gill
- School of Pharmacy, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - John A Kellum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Patel NM, Stottlemyer BA, Gray MP, Boyce RD, Kane-Gill SL. A Pharmacovigilance Study of Adverse Drug Reactions Reported for Cardiovascular Disease Medications Approved Between 2012 and 2017 in the United States Food and Drug Administration Adverse Event Reporting System (FAERS) Database. Cardiovasc Drugs Ther 2021; 36:309-322. [PMID: 33599896 DOI: 10.1007/s10557-021-07157-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Between 2012 and 2017, the FDA approved 29 therapies for a cardiovascular disease (CVD) indication. Due to the limited literature on patient safety outcomes for recently approved CVD medications, this study investigated adverse drug reports (ADRs) reported in the FDA Adverse Event Reporting System (FAERS). METHODS A disproportionality analysis of spontaneously reported ADR was conducted. Reports in FAERS from Quarter 1, 2012, through Quarter 1, 2019, were compiled, allowing a 2-year buffer following drug approval in 2017. Top 10 reported ADRs and reporting odds ratios (ROR; confidence interval (CI)), a measure of disproportionality, were analyzed and compared to drugs available prior to 2012 as appropriate. RESULTS Of 7,952,147 ADR reports, 95,016 (1.19%) consisted of reports for newly approved CVD medications. For oral anticoagulants, apixaban had significantly lower reports for anemia and renal failure compared to dabigatran and rivaroxaban but greater reports for neurological signs/symptoms, and arrhythmias. Evaluating heart failure drugs, sacubitril/valsartan had greater reports for acute kidney injury, coughing, potassium imbalances, and renal impairment but notably, lower for angioedema compared to lisinopril. Assessing familial hypercholesterolemia drugs, alirocumab had greater reports for joint-related-signs/symptoms compared to other agents in this category. A newer pulmonary arterial hypertension treatment, selexipag, had greater reports of reporting for bone/joint-related-signs/symptoms but riociguat had greater reports for hemorrhages and vascular hypotension. CONCLUSION Pharmacovigilance studies allow an essential opportunity to evaluate the safety profile of CVD medications in clinical practice. Additional research is needed to evaluate these reported safety concerns for recently approved CVD medications.
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Affiliation(s)
- Niti M Patel
- School of Pharmacy, University of Pittsburgh, 3507 Terrace St., Pittsburgh, PA, 15261, USA
| | - Britney A Stottlemyer
- School of Pharmacy, University of Pittsburgh, 3507 Terrace St., Pittsburgh, PA, 15261, USA
| | - Matthew P Gray
- School of Pharmacy, University of Pittsburgh, 3507 Terrace St., Pittsburgh, PA, 15261, USA
| | - Richard D Boyce
- School of Pharmacy, University of Pittsburgh, 3507 Terrace St., Pittsburgh, PA, 15261, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, 3507 Terrace St., Pittsburgh, PA, 15261, USA.
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Abstract
Drugs are the third leading cause of acute kidney injury (AKI) in critically ill patients. Nephrotoxin stewardship ensures a structured and consistent approach to safe medication use and prevention of patient harm. Comprehensive nephrotoxin stewardship requires coordinated patient care management strategies for safe medication use, ensuring kidney health, and avoiding unnecessary costs to improve the use of nephrotoxins, renally eliminated drugs, and kidney disease treatments. Implementing nephrotoxin stewardship reduces medication errors and adverse drug events, prevents or reduces severity of drug-associated AKI, prevents progression to or worsening of chronic kidney disease, and alleviates financial burden on the health care system.
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Affiliation(s)
- Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, Center for Critical Care Nephrology, School of Medicine, University of Pittsburgh, PRESBY/SHY Pharmacy Administration Building, 3507 Victoria Street, Mailcode PFG-01-01-01, Pittsburgh, PA 15213, USA.
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Suh K, Kellum JA, Kane-Gill SL. A systematic review of cost-effectiveness analyses across the acute kidney injury landscape. Expert Rev Pharmacoecon Outcomes Res 2021; 21:571-578. [PMID: 33522323 DOI: 10.1080/14737167.2021.1882307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Acute kidney injury (AKI) is a complex and common condition associated with increased morbidity, mortality, and costs. Evidence from cost-effectiveness analysis (CEA) have targeted various aspects of AKI including detection with biomarkers, treatment with renal replacement therapy, and prevention when using contrast media. However, there has not been a systematic review of these studies across the entirety of AKI.Areas covered: PubMed, Embase, and Cochrane library were used to identify CEA studies that involved AKI from 2004 onwards. These studies compared AKI treatment through renal replacement therapies (n = 6), prevention of contrast-induced-AKI (CI-AKI) using different media (n = 3), and diagnosis with novel biomarkers (n = 2). Treatment strategies for AKI focused on continuous versus intermittent renal replacement therapy. While there was no consensus, the majority of studies favored the continuous form. For contrast media, both studies found iodixanol to be cost-effective compared to iohexol for preventing CI-AKI. Additionally, novel biomarkers showed potential to be cost-effective in risk assessment and detection of AKI.Expert opinion: Consistent criteria such as a lifetime time horizon would allow for better model comparisons. Further research on clinical parameters to capture transition probabilities between stages within AKI and progression to downstream kidney disease is needed.
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Affiliation(s)
- Kangho Suh
- University of Pittsburgh, Pittsburgh, PA, USA
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sandra L Kane-Gill
- University of Pittsburgh, Pittsburgh, PA, USA.,Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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43
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Moreland-Head LN, Coons JC, Seybert AL, Gray MP, Kane-Gill SL. Use of Disproportionality Analysis to Identify Previously Unknown Drug-Associated Causes of Cardiac Arrhythmias Using the Food and Drug Administration Adverse Event Reporting System (FAERS) Database. J Cardiovasc Pharmacol Ther 2021; 26:341-348. [PMID: 33403858 DOI: 10.1177/1074248420984082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Drug-induced QTc-prolongation is a well-known adverse drug reaction (ADR), however there is limited knowledge of other drug-induced arrhythmias. PURPOSE The objective of this study is to determine the drugs reported to be associated with arrhythmias other than QTc-prolongation using the FAERS database, possibly identifying potential drug causes that have not been reported previously. METHODS FAERS reports from 2004 quarter 1 through 2019 quarter 1 were combined to create a dataset of approximately 11.6 million reports. Search terms for arrhythmias of interest were selected from the Standardized MedDRA Queries (SMQ) Version 12.0. Frequency of the cardiac arrhythmias were determined for atrial fibrillation, atrioventricular block, bradyarrhythmia, bundle branch block, supraventricular tachycardia, and ventricular fibrillation and linked to the reported causal medications. Reports were further categorized by prior evidence associations using package inserts and established drug databases. A reporting odds ratio (ROR) and confidence interval (CI) were calculated for the ADRs for each drug and each of the 6 cardiac arrhythmias. RESULTS Of the 11.6 million reports in the FAERS database, 68,989 were specific to cardiac arrhythmias of interest. There were 61 identified medication-reported arrhythmia pairs for the 6 arrhythmia groups with 33 found to have an unknown reported association. Rosiglitazone was the most frequently medication reported across all arrhythmias [ROR 6.02 (CI: 5.82-6.22)]. Other medications with significant findings included: rofecoxib, digoxin, alendronate, lenalidomide, dronedarone, zoledronic acid, adalimumab, dabigatran, and interferon beta-1b. CONCLUSION Upon retrospective analysis of the FAERS database, the majority of drug-associated arrhythmias reported were unknown suggesting new potential drug causes. Cardiac arrhythmias other than QTc prolongation are a new area of focus for pharmacovigilance and medication safety. Consideration of future studies should be given to using the FAERS database as a timely pharmacovigilance tool to identify unknown adverse events of medications.
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Affiliation(s)
| | - James C Coons
- Department of Pharmacy, 6595UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
| | - Amy L Seybert
- Department of Pharmacy, 6595UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
| | - Matthew P Gray
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
| | - Sandra L Kane-Gill
- Department of Pharmacy, 6595UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
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44
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Kane-Gill SL, Wong A, Culley CM, Perera S, Reynolds MD, Handler SM, Kellum JA, Aspinall MB, Pellett ME, Long KE, Nace DA, Boyce RD. Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events. J Am Geriatr Soc 2020; 69:530-538. [PMID: 33233016 DOI: 10.1111/jgs.16946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Federally-mandated consultant pharmacist-conducted retrospective medication regimen reviews (MRRs) are designed to improve medication safety in nursing homes (NH). However, MRRs are potentially ineffective. A new model of care that improves access to and efficiency of consultant pharmacists is needed. The objective of this study was to determine the impact of pharmacist-led telemedicine services on reducing high-risk medication adverse drug events (ADEs) for NH residents using medication reconciliation and prospective MRR on admission plus ongoing clinical decision support alerts throughout the residents' stay. DESIGN Quality improvement study using a stepped-wedge design comparing the novel service to usual care in a one-year evaluation from November 2016 to October 2017. SETTING Four NHs (two urban, two suburban) in Southwestern Pennsylvania. PARTICIPANTS All residents in the four NHs were screened. There were 2,127 residents admitted having 652 alerts in the active period. INTERVENTION Upon admission, pharmacists conducted medication reconciliation and prospective MRR for residents and also used telemedicine for communication with cognitively-intact residents. Post-admission, pharmacists received clinical decision support alerts to conduct targeted concurrent MRRs and telemedicine. MEASUREMENT Main outcome was incidence of high-risk medication, alert-specific ADEs. Secondary outcomes included all-cause hospitalization, 30-day readmission rates, and consultant pharmacists' recommendations. RESULTS Consultant pharmacists provided 769 recommendations. The intervention group had a 92% lower incidence of alert-specific ADEs than usual care (9 vs 31; 0.14 vs 0.61/1,000-resident-days; adjusted incident rate ratio (AIRR) = 0.08 (95% confidence interval (CI) = 0.01-0.40]; P = .002). All-cause hospitalization was similar between groups (149 vs 138; 2.33 vs 2.70/1,000-resident-days; AIRR = 1.06 (95% CI = 0.72-1.58); P = .75), as were 30-day readmissions (110 vs 102; 1.72 vs 2.00/1,000-resident-days; AIRR = 1.21 (95% CI = 0.76-1.93); P = .42). CONCLUSIONS This is the first evaluation of the impact of pharmacist-led patient-centered telemedicine services to manage high-risk medications during transitional care and throughout the resident's NH stay, supporting a new model of patient care.
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Affiliation(s)
- Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | - Adrian Wong
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Colleen M Culley
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maureen D Reynolds
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven M Handler
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica B Aspinall
- RxPartners Inc., UMPC Diversified Services, Bridgeville, Pennsylvania, USA
| | - Megan E Pellett
- RxPartners Inc., UMPC Diversified Services, Bridgeville, Pennsylvania, USA
| | - Keith E Long
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David A Nace
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard D Boyce
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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45
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Ostermann M, Zarbock A, Goldstein S, Kashani K, Macedo E, Murugan R, Bell M, Forni L, Guzzi L, Joannidis M, Kane-Gill SL, Legrand M, Mehta R, Murray PT, Pickkers P, Plebani M, Prowle J, Ricci Z, Rimmelé T, Rosner M, Shaw AD, Kellum JA, Ronco C. Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement. JAMA Netw Open 2020; 3:e2019209. [PMID: 33021646 DOI: 10.1001/jamanetworkopen.2020.19209] [Citation(s) in RCA: 290] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE In the last decade, new biomarkers for acute kidney injury (AKI) have been identified and studied in clinical trials. Guidance is needed regarding how best to incorporate them into clinical practice. OBJECTIVE To develop recommendations on AKI biomarkers based on existing data and expert consensus for practicing clinicians and researchers. EVIDENCE REVIEW At the 23rd Acute Disease Quality Initiative meeting, a meeting of 23 international experts in critical care, nephrology, and related specialties, the panel focused on 4 broad areas, as follows: (1) AKI risk assessment; (2) AKI prediction and prevention; (3) AKI diagnosis, etiology, and management; and (4) AKI progression and kidney recovery. A literature search revealed more than 65 000 articles published between 1965 and May 2019. In a modified Delphi process, recommendations and consensus statements were developed based on existing data, with 90% agreement among panel members required for final adoption. Recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluations system. FINDINGS The panel developed 11 consensus statements for biomarker use and 14 research recommendations. The key suggestions were that a combination of damage and functional biomarkers, along with clinical information, be used to identify high-risk patient groups, improve the diagnostic accuracy of AKI, improve processes of care, and assist the management of AKI. CONCLUSIONS AND RELEVANCE Current evidence from clinical studies supports the use of new biomarkers in prevention and management of AKI. Substantial gaps in knowledge remain, and more research is necessary.
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Affiliation(s)
- Marlies Ostermann
- Department of Critical Care and Nephrology, King's College London, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Stuart Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Nephrology Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Etienne Macedo
- Division of Nephrology, Department of Medicine, University of California, San Diego
| | - Raghavan Murugan
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Max Bell
- Department of Perioperative Medicine and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lui Forni
- Intensive Care Unit, Royal Surrey Hospital NHS Foundation Trust, Surrey, United Kingdom
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Surrey, United Kingdom
| | - Louis Guzzi
- Department of Critical Care Medicine, AdventHealth Waterman, Orlando, Florida
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Mathieu Legrand
- Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - Ravindra Mehta
- Department of Medicine, UCSD Medical Center, University of California, San Diego
| | | | - Peter Pickkers
- Department of Intensive Care Medicine, Nijmegen Medical Center, Radboud University, Nijmegen, the Netherlands
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - John Prowle
- William Harvey Research Institute, Royal London Hospital, Queen Mary University of London, London, United Kingdom
| | - Zaccaria Ricci
- Pediatric Cardiac Intensive Care Unit, Bambino Gesu Children's Hospital, Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Mitchell Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville
| | - Andrew D Shaw
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padova, Italy
- Department of Nephrology, Dialysis, and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
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46
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Levito MN, Coons JC, Verrico MM, Szymkowiak A, Legler B, Dueweke EJ, Kane-Gill SL. A Systemwide Approach for Navigating the Dilemma of Oral Factor Xa Inhibitor Interference With Unfractionated Heparin Anti-Factor Xa Concentrations. Ann Pharmacother 2020; 55:618-623. [PMID: 32885997 DOI: 10.1177/1060028020956271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Oral factor Xa inhibitors are known to significantly increase heparin anti-Xa concentrations, which leads to inaccuracies when monitoring intravenous unfractionated heparin (IV UFH). Guidance for managing this laboratory interference is lacking, creating substantial uncertainty in clinical practice. OBJECTIVE To describe a strategy used by a large academic institution for managing the controversy of laboratory interference in the setting of oral factor Xa inhibitor use and provide effectiveness and safety data for this approach. METHODS In December 2016, a new Heparin IV Direct Oral Anticoagulant (DOAC) Interference PowerPlan (a comprehensive order set) was made available in the electronic health record (Cerner, North Kansas City, MO) throughout the health system. We retrospectively examined 169 patients with events reported in the error reporting system, RISKMASTER, and evaluated reports with and without the use of the PowerPlan. Effectiveness was determined through evaluation of thrombosis. The Naranjo criteria for causality were applied to assess thrombotic events. RESULTS Of 56 events that were reported with apixaban when the PowerPlan was not ordered, 4 (7%) thrombotic events occurred within 7 days of UFH initiation. One out of the 4 events (25%) that occurred when the PowerPlan was not appropriately initiated was considered probable using the Naranjo Scale. Three additional events (75%) were possible using the Naranjo Scale. CONCLUSION AND RELEVANCE The Heparin IV DOAC Interference PowerPlan appears to be conducive to positive patient outcomes when evaluating voluntary reported events and may assist clinicians with managing the therapeutic dilemma of this laboratory interference.
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Affiliation(s)
| | - James C Coons
- UPMC Presbyterian-Shadyside, Pittsburgh, PA, USA.,University of Pittsburgh-School of Pharmacy, Pittsburgh, PA, USA
| | | | | | - Brianna Legler
- UPMC Presbyterian-Shadyside, Pittsburgh, PA, USA.,Duquesne University, Pittsburgh, PA, USA
| | | | - Sandra L Kane-Gill
- UPMC Presbyterian-Shadyside, Pittsburgh, PA, USA.,University of Pittsburgh-School of Pharmacy, Pittsburgh, PA, USA
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47
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Andreaggi CA, Novak EA, Mirabile ME, Sampathkumar S, Gray MP, He M, Kane-Gill SL. Safety concerns reported by consumers, manufacturers and healthcare professionals: A detailed evaluation of opioid-related adverse drug reactions in the FDA database over 15 years. Pharmacoepidemiol Drug Saf 2020; 29:1627-1635. [PMID: 32851782 DOI: 10.1002/pds.5105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/06/2022]
Abstract
To perform an in-depth analysis of opioid-related ADRs reported by consumers, manufacturers and healthcare professionals. Delving into the depth and breadth of reported opioid-related adverse drug reactions (ADRs) provides an opportunity to strategize better clinical management and alleviate safety concerns. Retrospective pharmacovigilance disproportionality analysis for opioid-related ADRs in the FDA Adverse Event Reporting System (FAERS) database was performed. Detailed analysis of patient (sex, age) and report (year of report; reporter: healthcare worker vs consumer) characteristics were conducted using reports from 2004 quarter 1 to 2018 quarter 4. Reporting odds ratios and confidence intervals (RORs,CI) were calculated. Of the 1 916 674 ADR reports, 300 985 indicated opioids as the primary medication. There was a surge in opioid-related ADRs reported in 2018 with six times more reports compared to 2004 and twice the number of reports compared to 2017. The largest ROR among the 20 common ADRs was depression and suicide-self-injury (ROR 3.12, 95% CI 3.01-3.22) for reports in age group ≥65 compared to age group 18 to 64, and lack of efficacy (ROR 6.80, 95% CI 6.61-7.00) for males compared to females. ADRs with the largest RORs for consumers included lack of efficacy/effect (ROR 3.37, 95% CI 3.28-3.46), administration site reactions (ROR 3.21, 95% CI 3.11-3.32), depression and suicide self-injury (ROR 2.26, 95% CI 2.14-2.38) compared to healthcare professionals. Important aspects of opioid ADR voluntary reporting included suicidal ideation in elderly patients and lack of efficacy, especially in male patients. This examination provides insight to better manage safety concerns of opioids.
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Affiliation(s)
| | - Emily A Novak
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Matthew P Gray
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meiqi He
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
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48
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Ammar MA, Sacha GL, Welch SC, Bass SN, Kane-Gill SL, Duggal A, Ammar AA. Sedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug Shortages. J Intensive Care Med 2020; 36:157-174. [PMID: 32844730 DOI: 10.1177/0885066620951426] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The rapid spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic. The 2019 coronavirus disease (COVID-19) presents with a spectrum of symptoms ranging from mild to critical illness requiring intensive care unit (ICU) admission. Acute respiratory distress syndrome is a major complication in patients with severe COVID-19 disease. Currently, there are no recognized pharmacological therapies for COVID-19. However, a large number of COVID-19 patients require respiratory support, with a high percentage requiring invasive ventilation. The rapid spread of the infection has led to a surge in the rate of hospitalizations and ICU admissions, which created a challenge to public health, research, and medical communities. The high demand for several therapies, including sedatives, analgesics, and paralytics, that are often utilized in the care of COVID-19 patients requiring mechanical ventilation, has created pressure on the supply chain resulting in shortages in these critical medications. This has led clinicians to develop conservation strategies and explore alternative therapies for sedation, analgesia, and paralysis in COVID-19 patients. Several of these alternative approaches have demonstrated acceptable levels of sedation, analgesia, and paralysis in different settings but they are not commonly used in the ICU. Additionally, they have unique pharmaceutical properties, limitations, and adverse effects. This narrative review summarizes the literature on alternative drug therapies for the management of sedation, analgesia, and paralysis in COVID-19 patients. Also, this document serves as a resource for clinicians in current and future respiratory illness pandemics in the setting of drug shortages.
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Affiliation(s)
- Mahmoud A Ammar
- Department of Pharmacy, 25047Yale-New Haven Health System, New Haven, CT, USA
| | - Gretchen L Sacha
- Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Sarah C Welch
- Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie N Bass
- Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA
| | | | - Abhijit Duggal
- Respiratory Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Abdalla A Ammar
- Department of Pharmacy, 25047Yale-New Haven Health System, New Haven, CT, USA
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Camacho J, Zanoletti-Mannello M, Landis-Lewis Z, Kane-Gill SL, Boyce RD. A Conceptual Framework to Study the Implementation of Clinical Decision Support Systems (BEAR): Literature Review and Concept Mapping. J Med Internet Res 2020; 22:e18388. [PMID: 32759098 PMCID: PMC7441385 DOI: 10.2196/18388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 01/03/2023] Open
Abstract
Background The implementation of clinical decision support systems (CDSSs) as an intervention to foster clinical practice change is affected by many factors. Key factors include those associated with behavioral change and those associated with technology acceptance. However, the literature regarding these subjects is fragmented and originates from two traditionally separate disciplines: implementation science and technology acceptance. Objective Our objective is to propose an integrated framework that bridges the gap between the behavioral change and technology acceptance aspects of the implementation of CDSSs. Methods We employed an iterative process to map constructs from four contributing frameworks—the Theoretical Domains Framework (TDF); the Consolidated Framework for Implementation Research (CFIR); the Human, Organization, and Technology-fit framework (HOT-fit); and the Unified Theory of Acceptance and Use of Technology (UTAUT)—and the findings of 10 literature reviews, identified through a systematic review of reviews approach. Results The resulting framework comprises 22 domains: agreement with the decision algorithm; attitudes; behavioral regulation; beliefs about capabilities; beliefs about consequences; contingencies; demographic characteristics; effort expectancy; emotions; environmental context and resources; goals; intentions; intervention characteristics; knowledge; memory, attention, and decision processes; patient–health professional relationship; patient’s preferences; performance expectancy; role and identity; skills, ability, and competence; social influences; and system quality. We demonstrate the use of the framework providing examples from two research projects. Conclusions We proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models.
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Affiliation(s)
- Jhon Camacho
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,I&E Meaningful Research, Bogotá, Colombia
| | | | - Zach Landis-Lewis
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Richard D Boyce
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Ostermann M, Bellomo R, Burdmann EA, Doi K, Endre ZH, Goldstein SL, Kane-Gill SL, Liu KD, Prowle JR, Shaw AD, Srisawat N, Cheung M, Jadoul M, Winkelmayer WC, Kellum JA. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int 2020; 98:294-309. [PMID: 32709292 PMCID: PMC8481001 DOI: 10.1016/j.kint.2020.04.020] [Citation(s) in RCA: 218] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/31/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022]
Abstract
In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) published a guideline on the classification and management of acute kidney injury (AKI). The guideline was derived from evidence available through February 2011. Since then, new evidence has emerged that has important implications for clinical practice in diagnosing and managing AKI. In April of 2019, KDIGO held a controversies conference entitled Acute Kidney Injury with the following goals: determine best practices and areas of uncertainty in treating AKI; review key relevant literature published since the 2012 KDIGO AKI guideline; address ongoing controversial issues; identify new topics or issues to be revisited for the next iteration of the KDIGO AKI guideline; and outline research needed to improve AKI management. Here, we present the findings of this conference and describe key areas that future guidelines may address.
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Affiliation(s)
- Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, King's College London, London, UK.
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emmanuel A Burdmann
- Laboratório de Investigação Médica 12, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan
| | - Zoltan H Endre
- Prince of Wales Hospital and Clinical School, University of New South Wales, Randwick, NSW, Australia
| | - Stuart L Goldstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Kathleen D Liu
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, California, USA; Department of Anesthesia, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, California, USA
| | - John R Prowle
- William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Andrew D Shaw
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Academy of Science, Royal Society of Thailand, Bangkok, Thailand
| | - Michael Cheung
- Kidney Disease: Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - John A Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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