Risk of Acute Kidney Injury Associated With Medication Administration in the Emergency Department

Jeremiah S. Hinson, Michael R. Ehmann, Nour Al Jalbout, Melinda J. Ortmann, Juliana Zschoche, Eili Y. Klein

Research output: Contribution to journalArticlepeer-review

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 languageEnglish (US)
Pages (from-to)487-496
Number of pages10
JournalJournal of Emergency Medicine
Volume58
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • acute kidney injury
  • drug-induced kidney disease
  • emergency department
  • nephrotoxins

ASJC Scopus subject areas

  • Emergency Medicine

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