Abstract
Background: Patients who develop acute kidney injury (AKI) have a 2-fold increased risk for major adverse events within 1 year. An estimated 19–26% of all cases of hospital-acquired AKI may be attributable to drug-induced kidney disease (DIKD). Patients evaluated in the emergency department (ED) are often prescribed potentially nephrotoxic drugs, yet the role of ED prescribing in DIKD is unknown. Objective: We sought to measure the association between ED medication administration and development of AKI. Methods: This was a retrospective 5-year cohort analysis at a single center. Patients with a serum creatinine measurement at presentation in the ED and 24–168 h later were included. Outcome was incidence of AKI as defined by Kidney Disease Improving Global Outcomes criteria in the 7 days after ED evaluation. Medication administration risk was estimated using Cox proportional hazards model. Results: There were 46,965 ED encounters by 30,407 patients included in the study, of which 6461 (13.8%) patients met the criteria for AKI. For hospitalized patients, administration of a potentially nephrotoxic medication was associated with increased risk of AKI (hazard ratio [HR] 1.30 [95% confidence interval {CI} 1.20–1.41]). Diuretics were associated with the largest risk of AKI (HR 1.64 [95% CI 1.52–1.78]), followed by angiotensin-converting enzyme inhibitors (HR 1.39 [95% CI 1.26–1.54]) and antibiotics (HR 1.13 [95% CI 1.05–1.22]). For discharged patients, administration of antibiotics was strongly associated with increased risk of AKI (HR 3.19 [95% CI 1.08–9.43]). Conclusion: ED administration of potentially nephrotoxic medications was associated with an increased risk of AKI in the following 7 days. Diuretics, angiotensin-converting enzyme inhibitors, and antibiotics were independently associated with increased risk of AKI. Nephroprotective practices in the ED may mitigate kidney injury and long-term adverse outcomes.
Original language | English (US) |
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Pages (from-to) | 487-496 |
Number of pages | 10 |
Journal | Journal of Emergency Medicine |
Volume | 58 |
Issue number | 3 |
DOIs | |
State | Published - Mar 2020 |
Keywords
- acute kidney injury
- drug-induced kidney disease
- emergency department
- nephrotoxins
ASJC Scopus subject areas
- Emergency Medicine