Nephrotoxic Medication Exposure and Clinical Outcomes Following Acute Kidney Injury

Abstract

Acute kidney injury (AKI) is a common comorbidity in patients admitted to hospitals and can also be affected by exposure to potentially nephrotoxic drugs. Medication-related and clinical predictors of adverse outcomes can be identified, which is significant to enhance risk assessment and management. An analytical study, secondary-data study was carried out on a subset of 1,000 cases of hospitalized adults with AKI based on ELAIA-2 dataset that was cleaned. ACEi/ARB, NSAIDs and PPIs exposure were evaluated in relation to AKI progression, dialysis, mortality and composite adverse outcomes. Descriptive statistics, chi-square tests, independent samples t-tests, correlation and regression were used. Crude associations between PPI exposure and AKI progression, dialysis, death, and composite outcome were significant. There were lower rates of selected outcomes with ACEi/ARB and NSAID exposure in the unadjusted analysis. Nonetheless, the composite outcome was not adjusted and independently related to individual medication classes. The overall outcome, AKI progression, death and dialysis were always predicted by the higher SOFA score. Predictors of 14-day mortality were age, and predictors of dialysis were baseline creatinine. Clinical severity and baseline renal status seemed to be more critical predictors of short-term outcomes of AKI compared to medication exposure alone. Close review of medications should thus be coupled with evaluation of severity of systemic illness and renal function.