Drug-induced acute kidney injury among medical inpatients of therapeutic profile


DOI: https://dx.doi.org/10.18565/therapy.2021.6.18-23

Nikitin E.Yu., Shakhnova E.A., Osipova A.V., Vorykhanov A.V., Uyanaeva M.A., Melkonyan G.G., Drozdov V.N., Shikh E.V.

1) I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University); 2) City Clinical Hospital No. 4 of the Moscow Healthcare Department
Abstract. The aim: to assess the incidence of drug-Induced acute kidney injury (AKI) in patients of the therapeutic, cardiological, and rheumatological departments of the hospital.
Material and methods. The frequency of AKI was assessed by the method of retrospective analysis in 2400 patients in therapeutic departments, after prescribing and/or changing the dosage of the following drugs: ACE inhibitors, angiotensin II receptor blockers (ARB), furosemide, NSAIDs, «nephrotoxic antibiotics» – levofloxacin, amikacin, vancomycin.
Results. AKI developed in 4,2% (CI 95%: 3,43–5,1%) of the patient (n=101). The development of AKI was recorded after the appointment of furosemide in 42% of cases, ACE inhibitors – in 24%, ARB – in 16%. In 14 (8%) patients, the development of AKI was associated with the prescription of NSAIDs, and in 10% of patients with the prescription of antibiotics. 46 (45,5%) patients received two drugs from the evaluated group at the same time, 40 (39,6%) were prescribed one of the drugs, and 15 (14,9%) patients received 3 or more drugs at the same time. In 14 (13,9%) patients, the doses of 3 drugs were prescribed and/or changed for the therapy, and in 1 patient, 4 drugs at once. 83 (82,2%) patients developed AKI grade 1, 8 (7,9%) – grade 2, and 10 (9,9%) – grade 3. AKI severity was correlated with renal function prior to therapy correction. When conducting ROC analysis between the severity of AKI and the level of glomerular filtration, a statistically significant relationship was found: AUCROC = 0,693 (95% CI: 0,594–0,781; p=0,03). The number of drugs prescribed did not have a significant effect on the severity of AKI. The frequency of AKI development among patients of a therapeutic hospital ranged from 3,43 to 5,1%.
Conclusion. Admission of patients to a hospital in connection with an exacerbation or worsening of the course of arterial hypertension, chronic heart failure and other diseases leads to the intensification of previously conducted therapy or replacement of drugs. Such adjustment of treatment may be associated with the risk of developing AKI.
Keywords: nephrotoxic antibiotics, furosemide, angiotensin II receptor blockers, ACE inhibitors, acute kidney injury
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About the Autors

Evgeny Yu. Nikitin, postgraduate of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. Tel.: +7 (495) 915-58-01. E-mail: E.U.Nikitin@ya.ru. ORCID: 0000-0001-5274-1570
Elena A. Shakhnova, PhD, nephrologist of City Clinical Hospital No. 4 of the Moscow Healthcare Department. Address: 115093, Moscow, 25 Pavlovskaya Str. ORCID: 0000-0002-4462-0653
Alesya V. Osipova, nephrologist of City Clinical Hospital No. 4 of the Moscow Healthcare Department. Address: 115093, Moscow, 25 Pavlovskaya Str. ORCID: 0000-0002-0409-8637
Andrey V Vorykhanov, PhD, deputy chief physician for anesthesiology and resuscitation of City Clinical Hospital No. 4 of the Moscow Healthcare Department. Address: 115093, Moscow, 25 Pavlovskaya Str. ORCID: 0000-0001-9597-5692
Maria A. Uyanaeva, PhD, deputy chief physician for therapeutic aid, therapist of City Clinical Hospital No. 4 of the Moscow Healthcare Department. Address: 115093, Moscow, 25 Pavlovskaya Str. ORCID: 0000-0003-2091-5120
Georgy G. Melkonyan, MD, professor, chief physician, surgeon of City Clinical Hospital No. 4 of the Moscow Healthcare Department. Address: 115093, Moscow, 25 Pavlovskaya Str. ORCID: 0000-0002-4021-5044
Vladimir N. Drozdov, MD, professor, professor of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. Tel.: +7 (495) 915-58-01. ORCID: 0000-0002-0535-2916
Evgenia V. Shikh, MD, professor, head of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119991, Moscow, 8/2 Trubetskaya Str. Tel.: +7 (495) 915-58-01. ORCID: 0000-0001-6589-7654


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