Background

Nephrotoxic drug prescription may contribute to acute kidney injury (AKI) occurrence and worsening among critically ill patients and thus to associated morbidity and mortality. The objectives of this study were to describe nephrotoxic drug prescription in a large intensive-care unit cohort and, through a case–control study nested in the prospective cohort, to evaluate the link of nephrotoxic prescription burden with AKI.

Results

Six hundred and seventeen patients (62%) received at least one nephrotoxic drug, among which 303 (30%) received two or more. AKI was observed in 609 patients (61%). A total of 351 patients were considered as cases developing or worsening AKI a given index day during the first week in the intensive-care unit. Three hundred and twenty-seven pairs of cases and controls (patients not developing or worsening AKI during the first week in the intensive-care unit, alive the case index day) matched on age, chronic kidney disease, and simplified acute physiology score 2 were analyzed. The nephrotoxic burden prior to the index day was measured in drug.days: each drug and each day of therapy increasing the burden by 1 drug.day. This represents a semi-quantitative evaluation of drug exposure, potentially easy to implement by clinicians. Nephrotoxic burden was significantly higher among cases than controls: odds ratio 1.20 and 95% confidence interval 1.04–1.38. Sensitivity analysis showed that this association between nephrotoxic drug prescription in the intensive-care unit and AKI was predominant among the patients with lower severity of disease (simplified acute physiology score 2 below 48).

Conclusions

The frequently observed prescription of nephrotoxic drugs to critically ill patients may be evaluated semi-quantitatively through computing drug.day nephrotoxic burden, an index significantly associated with subsequent AKI occurrence, and worsening among patients with lower severity of disease.

中文翻译：

---

1001名重症患者的肾毒性药物负担：对急性肾损伤的影响。

背景

肾毒性药物处方可能会导致重症患者的急性肾损伤（AKI）发生和恶化，从而导致相关的发病率和死亡率。这项研究的目的是描述一个大型重症监护病房队列中的肾毒性药物处方，并通过嵌套在前瞻性队列中的病例对照研究评估肾毒性处方负担与AKI的联系。

结果

617例患者（62％）至少接受了一种肾毒性药物，其中303例（30％）接受了两种或更多种。在609例患者中观察到AKI（61％）。在重症监护病房的第一周内，总共351名患者被认为是在给定的索引日发生或恶化AKI的病例。在年龄，慢性肾脏疾病和简化的急性生理学评分2匹配的327例病例和对照中（重症监护病房第一周未出现AKI恶化或恶化的患者，在病例索引日还活着）。分析。指标天之前的肾毒性负担以药物天数计量：每种药物和治疗的每一天将负担增加1药物天。这表示对药物暴露的半定量评估，可能容易被临床医生实施。病例中肾毒性负担明显高于对照组：优势比为1.20，95％置信区间为1.04至1.38。敏感性分析表明，在病情严重程度较低的患者中，重症监护病房的肾毒性药物处方与AKI之间的这种联系最为明显（简化的急性生理学评分2在48以下）。

结论

可以通过计算药物半定量评估重症患者经常使用的肾毒性药物处方。日肾毒性负荷是与随后的AKI发生显着相关的指数，并且在疾病严重程度较低的患者中恶化。