Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/32947
Title: Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study
Authors: Soares, Danielly Botelho
Mambrini, Juliana Vaz de Melo
Botelho, Gabriela Rebouças
Girundi, Flávia Fialho
Botoni, Fernando Antonio
Martins, Maria Auxiliadora Parreiras
Affilliation: Universidade Federal de Minas Gerais. Faculdade de Farmácia. Belo Horizonte, MG, Brazil.
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Farmácia. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Farmácia. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, Brazil/Hospital Risoleta Tolentino Neves. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Farmácia. Belo Horizonte, MG, Brazil / Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, Brazil / Hospital Risoleta Tolentino Neves. Belo Horizonte, MG, Brazil.
Abstract: Background: Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital. Methods: This is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (SCr) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression. Results: Overall, 122 participants were included in the study. Median age was 46.0 (interquartile range, IQ = 29.0-69.0) years, with a predominance of men (58.2%). Mean number of prescribed drugs throughout ICU stay was 22.0 ± 9.4. The number of potentially nephrotoxic drugs ranged from two to 24 per patient. A total of 29 (23.8%) ICU patients developed AKI. In the AKI-group, patients were older and showed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, higher rates of sedation, mechanical ventilation, and infection. More drugs in general and specifically more vasoactive drugs were prescribed for AKI group. Patients who developed AKI tended to have extended stays in the ICU and a lower probability of being discharged alive than patients with no AKI development. Model adjustments of logistic regression showed that the number of medications (OR 1.15; 95% CI [1.05-1.27]) was the only factor associated with AKI in this study. This association was independent of drug nephrotoxicity. Discussion: Intensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found that typical risk factors for AKI showed statistical association on bivariate analysis. The contribution of drug therapy in the occurrence of AKI in medical ICUs reinforces the need for prevention strategies focused on early recognition of renal dysfunction and interventions in drug therapy. These actions would help improve the quality of patient care and ensure progress towards medication safety.
Keywords: Clinical practice
Critical care
Drug utilization
Nephrotoxicity
Renal failure
keywords: Prática clinica
Cuidados intensivos
Utilização de drogas
Inflamação dos nefrons
Falência renal
Issue Date: 2018
Publisher: PeerJ Inc.
Citation: SOARES, Danielly Botelho et al. Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study. PeerJ, v. 6, p. 1-19, 2018.
DOI: 10.7717/peerj.5405. eCollection 2018
ISSN: 2167-8359
Copyright: open access
Appears in Collections:MG - IRR - Artigos de Periódicos

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