Quantifying the potential contribution of drugs to the occurrence of acute kidney injury in patients with chronic kidney disease

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Laville, Solène | Vendar, Janice | Massy, Ziad | Gras-Champel, Valérie | Moragny, Julien | Frimat, Luc | Laville, Maurice | Jacquelinet, Christian | Pecoits-Filho, Roberto | de Pinho, Natalia Alencar | Hamroun, Aghilès | Liabeuf, Sophie | Combe, Christian | Fouque, Denis | Lambert, Oriane | Lange, Céline | Metzger, Marie | Pascal, Christophe | Stengel, Bénédicte | Hannedouche, T | Moulin, B | Klein, A | Combe, C | Bourdenx, J | Keller, A | Delclaux, C | Vendrely, B | Deroure, B | Lacraz, A | Lobbedez, T | Landru, I | Lang, P | Belenfant, X | Thervet, E | Urena, P | Delahousse, M | Vela, C | Essig, M | Clément, D | Sekhri, H | Smati, M | Jamali, M | Hacq, B | Panescu, V | Bellou, M | Kamar, N | Noël, C | Glowacki, F | Maisonneuve, N | Azar, R | Hoffmann, M | Hourmant, M | Testa, A | Besnier, D | Choukroun, G | Lambrey, G | Burtey, S | Lebrun, G | Magnant, E | Laville, M | Fouque, D | Juillard, L | Chazot, C | Zaoui, P | Kuentz, F

Edité par CCSD ; Oxford University Press -

International audience. Background We sought to comprehensively describe drug-related components associated with AKI in patients with CKD, describing the incidence of drug-related AKI, the proportion of preventable AKI, identified the various drugs potentially associated with it, explored the risk factors, and assessed the one-year incidences of the recurrence of drug-related AKI, kidney failure, and death. Methods CKD-REIN is a French national prospective cohort of 3,033 nephrology outpatients with a confirmed diagnosis of CKD (eGFR <60 mL/min/1.73 m²). AKIs and adverse drug reactions (ADRs) were prospectively identified from hospital reports, medical records, and patient interviews. Expert nephrologists used the KDIGO criteria to adjudicate all stages of AKI, and expert pharmacologists used validated tools to adjudicate ADRs (including drug-related AKIs). Results Over a median [interquartile range] period of 4.9 [3.4-5.1] years, 832 cases of AKI were reported in 639 (21%) of the 3,033 study participants. The drug-related component associated with AKI accounted for 236 cases, and 28% were judged to be preventable or potentially preventable. The three most frequently implicated drug classes were diuretics, renin-angiotensin system inhibitors, and contrast agents. A history of cardiovascular events, diabetes, lower levels of hemoglobin and eGFR, poor medication adherence, and ≥ 5 drug taken daily were associated with a greater risk of drug-related AKI. Full recovery was not attained in 64 (27%) of the 236 cases of drug-related AKI. The one-year cumulative incidences of recurrence of drug-related AKI, kidney replacement therapy, and death were 7%, 15%, and 11%, respectively, after the first drug-related AKI. Conclusions Drug-related AKI is prevalent among patients with CKD. Even though a substantial proportion of these events were classified as stage 1, our findings point to a poor prognosis.

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