FC 070USE OF POTENTIALLY NEPHROTOXIC MEDICATIONS IN PERSONS WITH CHRONIC KIDNEY DISEASE: PARALLEL COHORT STUDIES IN SWEDISH AND U.S ROUTINE CARE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alessandro Bosi ◽  
Juan Jesus Carrero ◽  
Jung-Im Shin ◽  
Yunwen Xu ◽  
Morgan Grams ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Adverse Drug Events ◽  
Medication Use ◽  
Kidney Injury ◽  
Routine Care ◽  
Clinical Predictors ◽  
Nephrotoxic Drugs ◽  
Study Inclusion ◽  
Swedish Cohort

Abstract Background and Aims Many adverse drug events are preventable, such as those potentially resulting from the prescription of nephrotoxic drugs to persons with chronic kidney disease (CKD). We here quantify the extent of contemporary nephrotoxic medication use in patients with CKD. Method In two observational cohorts of Swedish (Stockholm CREAtinine Measurements [SCREAM] project, Stockholm, Sweden) and U.S. (Geisinger Health System, Pennsylvania) adults with confirmed CKD stages G3-G5 undergoing routine care during 2016-2018, we explored the prescription (in U.S.) and dispensation (in Sweden) of 115 different ambulatory drugs with proven or purported nephrotoxicity during the 12 months following study inclusion. We evaluated the proportion of participants receiving nephrotoxic drugs, ranked main contributors and identified clinical predictors. Results In the Swedish cohort, there were 57880 patients (54.6% women) with median age of 80.00 (inter-quartile range [IQR]: 73.0-86.0) years and eGFR 48.9 ([IQR]: 39.9-55.0) mL/min/1.73 m2. In the U.S. cohort, there were 16255 patients (59% women) with median age of 76 years and eGFR 44 mL/min/1.73 m2. During observation, 20% (Sweden) and 17% (U.S.) of patients received at least one nephrotoxic drug. The top 3 potentially inappropriate nephrotoxic drugs identified were NSAIDs (9% and 11% of participants in U.S. and Sweden received it), antivirals (2.0% and 2.5%) and immunosuppressants (1.5% and 2.7%). Bisphosphonate use was common in Sweden (3.3% of participants), but not in U.S. (0.5%). Conversely, fenofibrates were common in U.S. (3.6%), but not in Sweden (0.13%). In adjusted analyses, patients with young age (<65 years old), women, or with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts (P>0.05 for all). Notably, patients aware of their CKD (identified either by issued diagnosis or recent visit to a nephrologist), were at lower risk of nephrotoxic drug use (OR 0.87, 95% CI 0.82-0.92 in Sweden and 0.89, 95% CI 0.81-1.01 in U.S.). Conclusion In two geographically distinct health systems, one in five patients with CKD received potentially inappropriate nephrotoxic medications, mainly NSAIDs. Strategies to increase CKD awareness and physician’s knowledge of drug nephrotoxicity may reduce inappropriate ambulatory prescriptions and prevent iatrogenic kidney injury.

P0624INCREASED URINARY BIOMARKERS OF KIDNEY INJURY IN PATIENTS AFTER ALLOGENETICHEMATOPOETIC STEM CELL TRANSPLANTATION REFLECT KIDNEY DAMAGE EVEN IN NORMALN KIDNEY FUNCTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Malgorzata Kepska ◽  
Inga Chomicka ◽  
Ewa Karakulska-Prystypiuk ◽  
Agnieszka Tomaszewska ◽  
Grzegorz Basak ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Stem Cell ◽  
Kidney Disease ◽  
Healthy Volunteers ◽  
Kidney Function ◽  
Kidney Injury ◽  
Allogeneic Hsct ◽  
Ckd Stage ◽  
Nephrotoxic Drugs

Abstract Background and Aims Chronic kidney disease (CKD) and acute kidney injury (AKI) are common complications of hematopoietic stem cell transplantation (HSCT) associated with increased morbidity and mortality. On the other hand, presence of CKD is often used as an exclusion criterion when selecting patients who undergo HSCT, especially when fludarabine in conditioning or GVHD prophylaxis with a calcineurin inhibitor is contemplated. There is also no threshold (CKD stage, level of serum creatinine etc) below which patients should not undergo allogeneic HSCT. Kidney function in patients undergoing HSCT is frequently worsened by previous chemotherapy and exposure to a variety of nephrotoxic drugs. Several biomarkers were widely investigated for early diagnosis of acute kidney injury, including neutrophil gelatinase associated lipocalin (NGAL), urinary liver-type fatty acid-binding protein (uL-FABP) and others, however, in patients undergoing HSCT, the published literature is exceptionally scarce. A few studies with inconclusive results stress the knowledge gap and need for further research. The aim of the study was to assess biomarkers of kidney injury in patients at least 3 months after HSCT (to avoid the effect of calcineurin inhibitors) under ambulatory care of Hematology, Oncology and Internal Medicine Department, University Teaching Hospital. Method We studied 80 prevalent patients after allogeneic HSCT and 32 healthy volunteers to obtained normal ranges for biomarkers. In this cross-sectional study following biomarkers of kidney injury in urine were evaluated: IGFBP-7/TIMP2 (insulin growth factor binding protein-7/, tissue inhibitor of metalloproteinases-2), netrin-1, semaphorin A2 using commercially available assays. Results All the biomarkers studied were significantly higher in patients after HSCT when compared to healthy volunteers (all p<0.001). When we divided patients according to kidney function (below and over 60 ml./min/1.72m2), we found that only concentration of IGFBP-7 was significantly higher in 23 patients with CKD stage 3 (i.e. eGFR below 60ml.min/1.72m2) relative to patients with eGFR over 60 ml.min.1.72m2. All biomarkers in both subgroups of patients with eGFR below and over 60 ml./min/1.72m2 were significantly higher relative to healthy volunteers. In univariate correlations sempahorinA2 was related to netrin 1 (r=0.47, p<0.001), IGFBP7 (r=0.35, p<0.01), TIMP2 (r=0.32, p<0.01), whereas IGFBP7 was positively related to serum creatinine (r=0.38, p<0.001) and inversely to eGFR (r=-0.36, p<0.001). Conclusion Concluding, patients after allogeneic HSCT despite normal or near normal kidney function show evidence of kidney injury, which might be due to comorbidities, previous chemotherapy, conditioning regimen,complement activation, calcineurin therapy after HSCT, other possible nephrotoxic drugs etc. Nephroprotective strategies are to be considered as chronic kidney disease is a risk factor for increased morbidity and mortality in this vulnerable population.

scholarly journals Glycemic control and the risk of acute kidney injury in patients with type 2 diabetes and chronic kidney disease: parallel population-based cohort studies in U.S. and Swedish routine care

2020 ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Marie Evans ◽  
Jung-Im Shin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Glycemic Control ◽  
Kidney Injury ◽  
Routine Care ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Swedish Cohort ◽  
The U.S

<b>Objective: </b>Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but mechanisms are unclear. We investigated the association of glycemic control with risk of AKI. <p><b>Research Design and Methods: </b>In two observational cohorts of U.S. (Geisinger Heath system, Pennsylvania) and Swedish (SCREAM project, Stockholm) adults with type-2 diabetes and confirmed CKD stages G3-G5 undergoing routine care, we evaluated associations between baseline and time-varying HbA1c with the incident AKI (defined as increase in creatinine ≥0.3 mg/dL over 48 hours, 1.5x creatinine over 7 days). </p> <p><b>Results: </b>In the U.S. cohort, there were 22877 patients (55% women) with median age 72 years and eGFR 52 ml/min/1.73 m<sup>2</sup>. In the Swedish cohort, there were 12157 patients (51% women) with median age 76 years and eGFR 51 ml/min/1.73 m<sup>2</sup>. During 3.1 and 2.3 years of follow-up, 7060 and 2619 AKI events were recorded in the U.S. and Swedish cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts. Compared to baseline HbA1c 6-6.9% (42-52 mmol/mol), the HR for AKI in patients with HbA1c>9% (75 mmol/mol) was 1.29 (95% CI 1.18-1.41) in Geisinger, and 1.33 (95% CI 1.13-1.57) in the Swedish cohort. Results were consistent in stratified analysis, when using death as competing risk, and when using time-varying HbA1c.</p> <p><b>Conclusions: </b>Higher HbA1c was associated with AKI in adults with type 2 diabetes and CKD, suggesting that improving glycemic control may reduce the risk of AKI.</p>

scholarly journals Glycemic control and the risk of acute kidney injury in patients with type 2 diabetes and chronic kidney disease: parallel population-based cohort studies in U.S. and Swedish routine care

2020 ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Marie Evans ◽  
Jung-Im Shin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Glycemic Control ◽  
Kidney Injury ◽  
Routine Care ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Swedish Cohort ◽  
The U.S

<b>Objective: </b>Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but mechanisms are unclear. We investigated the association of glycemic control with risk of AKI. <p><b>Research Design and Methods: </b>In two observational cohorts of U.S. (Geisinger Heath system, Pennsylvania) and Swedish (SCREAM project, Stockholm) adults with type-2 diabetes and confirmed CKD stages G3-G5 undergoing routine care, we evaluated associations between baseline and time-varying HbA1c with the incident AKI (defined as increase in creatinine ≥0.3 mg/dL over 48 hours, 1.5x creatinine over 7 days). </p> <p><b>Results: </b>In the U.S. cohort, there were 22877 patients (55% women) with median age 72 years and eGFR 52 ml/min/1.73 m<sup>2</sup>. In the Swedish cohort, there were 12157 patients (51% women) with median age 76 years and eGFR 51 ml/min/1.73 m<sup>2</sup>. During 3.1 and 2.3 years of follow-up, 7060 and 2619 AKI events were recorded in the U.S. and Swedish cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts. Compared to baseline HbA1c 6-6.9% (42-52 mmol/mol), the HR for AKI in patients with HbA1c>9% (75 mmol/mol) was 1.29 (95% CI 1.18-1.41) in Geisinger, and 1.33 (95% CI 1.13-1.57) in the Swedish cohort. Results were consistent in stratified analysis, when using death as competing risk, and when using time-varying HbA1c.</p> <p><b>Conclusions: </b>Higher HbA1c was associated with AKI in adults with type 2 diabetes and CKD, suggesting that improving glycemic control may reduce the risk of AKI.</p>

Risk Factors for Acute Kidney Injury and Chronic Kidney Disease following Allogeneic Hematopoietic Stem Cell Transplantation for Hematopoietic Malignancies

2019 ◽  
Vol 143 (5) ◽  
pp. 452-464 ◽  
Author(s):  
Masahiro Sakaguchi ◽  
Kazutaka Nakayama ◽  
Hiroki Yamaguchi ◽  
Akiko Mii ◽  
Akira Shimizu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Stem Cell ◽  
Kidney Disease ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Kidney Injury ◽  
Hematopoietic Stem ◽  
Nephrotoxic Drugs

Background: Acute kidney injury (AKI) and chronic kidney disease (CKD) are considered common complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Objectives and Method: In this study, 114 patients who had undergone allo-HSCT were retrospectively analyzed to investigate the risk factors for onset of posttransplant AKI and CKD as defined by the new Kidney Disease Improving Global Outcomes criteria. Results: Seventy-four patients (64.9%) developed AKI and 25 (21.9%) developed CKD. The multivariate analysis showed that the risk factors for developing stage 1 or higher AKI were age ≥46 years at the time of transplant (p = 0.001) and use of ≥3 nephrotoxic drugs (p = 0.036). For CKD, the associated risk factors were disease status other than complete remission at the time of transplantation (p = 0.018) and onset of AKI after transplant (p = 0.035). The 5-year overall survival (OS) was significantly reduced by development of AKI (p < 0.001), but not CKD. Posttransplant AKI significantly increased the 5-year nonrelapse mortality (p < 0.001), whereas posttransplant CKD showed an increasing tendency, but the difference was not significant. Conclusions: Posttransplant AKI impacts OS, significantly increases the risk of CKD, and is significantly associated with disseminated intravascular coagulation and use of ˃3 nephrotoxic drugs.

The kidney

2013 ◽  
pp. 185-193
Author(s):  
Mark Little ◽  
Alan Salama
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Function ◽  
Medication Use ◽  
Kidney Injury ◽  
Excretory Function ◽  
Rheumatological Disease ◽  
Glomerular Involvement ◽  
Work Up

Kidney dysfunction is common in patients with rheumatological disease, be it secondary to renal (usually glomerular) involvement by a multisystem rheumatological disorder, renal impairment due to nephrotoxic medication use, or incidentally noted during a rheumatological work-up. It is therefore important for the rheumatologist to know how to assess kidney function biochemically and radiologically, to appreciate when an organ-threatening process is present, and to understand the basic steps to take in the event of acute kidney injury. This chapter reviews assessment of kidney function with respect to estimating excretory function, and the degree of proteinuria and haematuria. It provides an in-depth review of the causes, assessment, and management of acute kidney injury as encountered in rheumatological practice, and a summary of the causes and approach to chronic kidney disease.

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