scholarly journals Acute Kidney Injury Pharmacokinetic Changes and Its Impact on Drug Prescription

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Author(s):  
Victoria Blanco ◽  
Carolina Hernandorena ◽  
Paula Scibona ◽  
Waldo Belloso ◽  
Carlos Musso
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Drug Prescription ◽  
Kidney Injury ◽  
Drug Dosage ◽  
Tubular Secretion ◽  
Metabolizing Enzymes ◽  
Drug Concentrations ◽  
The Impact

Acute kidney injury (AKI) is a common problem in hospitalized patients that is associated with significant morbid-mortality. The impact of kidney disease on the excretion of drugs eliminated by glomerular filtration and tubular secretion is well established, as well as the requirement for drug dosage adjustment in impaired kidney function patients. However, since impaired kidney function is associated with decreased activity of several hepatic and gastrointestinal drug-metabolizing enzymes and transporters, drugs doses adjustment only based on kidney alteration could be insufficient in AKI. In addition, there are significant pharmacokinetics changes in protein binding, serum amino acid levels, liver, kidney, and intestinal metabolism in AKI, thus the determination of plasma drug concentrations is a very useful tool for monitoring and dose adjustment in AKI patients. In conclusion, there are many pharmacokinetics changes that should be taken into account in order to perform appropriate drug prescriptions in AKI patients.

scholarly journals Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Benedict Morath ◽  
Andreas Meid ◽  
Johannes Rickmann ◽  
Jasmin Soethoff ◽  
Markus Verch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Kidney Function ◽  
Hydroxyethyl Starch ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Retrospective Cohort Analysis ◽  
The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

The impact of minimal invasive extracorporeal circulation on postoperative kidney function

Perfusion ◽  
2020 ◽  
pp. 026765912095460
Author(s):  
Ara Shwan Media ◽  
Peter Juhl-Olsen ◽  
Nils Erik Magnusson ◽  
Ivy Susanne Modrau
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Function ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Kidney Injury ◽  
Minimal Invasive ◽  
Mortality And Morbidity ◽  
The Impact

Introduction: Acute kidney injury following cardiac surgery is a frequent complication associated with increased mortality and morbidity. Minimal invasive extracorporeal circulation is suggested to preserve postoperative renal function. The aim of this study was to assess the impact of minimal invasive versus conventional extracorporeal circulation on early postoperative kidney function. Methods: Randomized controlled trail including 60 patients undergoing elective stand-alone coronary artery bypass graft surgery and allocated in a 1:1 ratio to either minimal invasive (n = 30) or conventional extracorporeal circulation (n = 30). Postoperative kidney injury was assessed by elevation of plasma neutrophil gelatinase-associated lipocalin (NGAL), a sensitive tubular injury biomarker. In addition, we assessed changes in estimated glomerular filtration rate (eGFR), and the incidence of acute kidney injury according to the Acute Kidney Injury Network (AKIN) classification. Results: We observed no differences between groups regarding increase of plasma NGAL (p = 0.31) or decline of eGFR (p = 0.82). In both groups, 6/30 patients developed acute kidney injury according to the AKIN classification, all regaining preoperative renal function within 30 days. Conclusion: Our findings challenge the superiority of minimal invasive compared to conventional extracorporeal circulation in terms of preservation of renal function following low-risk coronary surgery.

Drug Dosing in Acute Kidney Injury

2017 ◽  
Author(s):  
Steven Gabardi ◽  
Marjan Sadegh ◽  
Jamil Azzi ◽  
Craig A Stevens
Keyword(s):  
Acute Kidney Injury ◽  
Renal Dysfunction ◽  
Kidney Injury ◽  
Drug Clearance ◽  
Tubular Secretion ◽  
Drug Dosing ◽  
Drug Concentrations ◽  
Individualized Dosing ◽  
Altered Pharmacokinetic ◽  
Pharmacologic Agents

The prevalence of acute kidney injury (AKI) among hospitalized patients has increased sharply over the past 10 to 20 years. One complicating factor in this population is that many pharmacologic agents that are administered to these patients are handled, to some degree, by the kidneys. These medications may experience altered pharmacokinetic and pharmacodynamic profiles in patients with renal dysfunction, increasing the chances of drug misadventures. Historically, drug dosing in patients with AKI has been approached in the same manner as in patients with chronic renal insufficiency (CRI). The majority of dosing recommendations for AKI have been extrapolated from studies performed in patients with stable CRI. Renal drug clearance, composed of glomerular filtration, tubular secretion, and renal drug metabolism, is affected by renal dysfunction. It is clear that there is a reduction in renal clearance of drugs and toxins in both AKI and CRI. However, the type of renal dysfunction may affect other parameters of drug handling. Thus, dosing stratagems extrapolated from patients with CRI may result in subtherapeutic drug concentrations and ineffective treatment. Achieving a balance between under- and overdosing requires rigorous monitoring and individualized dosing.  Key words: acute kidney injury, drug dosing, pharmacokinetics

Drug Dosing in Acute Kidney Injury

2017 ◽  
Author(s):  
Steven Gabardi ◽  
Marjan Sadegh ◽  
Jamil Azzi ◽  
Craig A Stevens
Keyword(s):  
Acute Kidney Injury ◽  
Renal Dysfunction ◽  
Kidney Injury ◽  
Drug Clearance ◽  
Tubular Secretion ◽  
Drug Dosing ◽  
Drug Concentrations ◽  
Individualized Dosing ◽  
Altered Pharmacokinetic ◽  
Pharmacologic Agents

The prevalence of acute kidney injury (AKI) among hospitalized patients has increased sharply over the past 10 to 20 years. One complicating factor in this population is that many pharmacologic agents that are administered to these patients are handled, to some degree, by the kidneys. These medications may experience altered pharmacokinetic and pharmacodynamic profiles in patients with renal dysfunction, increasing the chances of drug misadventures. Historically, drug dosing in patients with AKI has been approached in the same manner as in patients with chronic renal insufficiency (CRI). The majority of dosing recommendations for AKI have been extrapolated from studies performed in patients with stable CRI. Renal drug clearance, composed of glomerular filtration, tubular secretion, and renal drug metabolism, is affected by renal dysfunction. It is clear that there is a reduction in renal clearance of drugs and toxins in both AKI and CRI. However, the type of renal dysfunction may affect other parameters of drug handling. Thus, dosing stratagems extrapolated from patients with CRI may result in subtherapeutic drug concentrations and ineffective treatment. Achieving a balance between under- and overdosing requires rigorous monitoring and individualized dosing.  Key words: acute kidney injury, drug dosing, pharmacokinetics

scholarly journals Impact of acute kidney injury on anticancer treatment dosage and long-term outcomes: a pooled analysis of European Organisation for Research and Treatment of Cancer trials

2020 ◽  
Author(s):  
Julien Péron ◽  
Anouk Neven ◽  
Laurence Collette ◽  
Vincent Launay-Vacher ◽  
Ben Sprangers ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Advanced Cancer ◽  
Kidney Injury ◽  
Dose Intensity ◽  
Long Term Outcomes ◽  
European Organisation ◽  
Treatment Dose ◽  
The Impact

Abstract Background The impact of kidney dysfunction on long-term outcomes of patients with advanced cancer remains unclear. Methods Patients with advanced cancer included in trials conducted by the European Organisation for Research and Treatment of Cancer were eligible for this retrospective analysis. Acute kidney injury (AKI) was identified using serum creatinine levels and using adverse events reported by investigators. The impact of baseline estimated glomerular filtration rates (eGFRs) on progression-free survival (PFS) and overall survival (OS) was investigated. Pooled estimates of the impact of AKI on dose intensity, treatment duration, PFS and OS were obtained following a meta-analytic process. Results Nine trials were included in this study, totalling 2872 metastatic patients with various tumour types and various systemic treatment types. Baseline eGFR had homogeneously no impact on PFS or OS. Most Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) events occurred early during the course of the treatment. AKI was not associated with an increased rate of treatment discontinuation, while it decreased the study treatment dose intensity. Occurrence of a first RIFLE event significantly and homogeneously reduced PFS (pooled hazard ratio = 1.18, 95% confidence interval 1.07–1.30; P = 0.0012), while its impact on OS was more heterogeneous across trials. Conclusion AKI is associated with reduced treatment dose intensity and reduced PFS. Therefore, close monitoring of the kidney function during the first months of treatment should be included in clinical trial protocols and probably also in daily practice to enable early AKI diagnosis and management. Collaboration between oncologists and nephrologists is needed to reduce the risk of undertreatment of patients experiencing AKI.

scholarly journals Preadmission kidney function and risk of acute kidney injury in patients hospitalized with acute pyelonephritis: A Danish population-based cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247687
Author(s):  
Henriette Vendelbo Graversen ◽  
Mette Nørgaard ◽  
Dorothea Nitsch ◽  
Christian Fynbo Christiansen
Keyword(s):  
Acute Kidney Injury ◽  
Risk Factor ◽  
Cohort Study ◽  
Kidney Function ◽  
Acute Pyelonephritis ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Population Based ◽  
The Impact ◽  
First Time

Background and objectives Only few smaller studies have examined if impaired kidney function increases the risk of acute kidney injury in patients with acute pyelonephritis. Therefore, we estimated 30-day risk of acute kidney injury by preadmission kidney function in patients with acute pyelonephritis. Furthermore, we examined if impaired kidney function was a risk factor for development of acute kidney injury in pyelonephritis patients. Methods This cohort study included patients with a first-time hospitalization with pyelonephritis from 2000 to 2017. Preadmission kidney function (estimated glomerular filtration rate (eGFR) <30, 30–44, 45–59, 60–89, and ≥90 ml/min/1.73 m2) and acute kidney injury within 30 days after admission were assessed using laboratory data on serum creatinine. The absolute 30-days risk of acute kidney injury was assessed treating death as a competing risk. The impact of eGFR on the odds of acute kidney injury was compared by odds ratios (ORs) with 95% confidence intervals estimated using logistic regression adjusted for potential confounding factors. Results Among 8,760 patients with available data on preadmission kidney function, 25.8% had a preadmission eGFR <60. The 30-day risk of acute kidney injury was 16% among patients with preadmission eGFR ≥90 and increased to 22%, 33%, 42%, and 47% for patients with preadmission eGFR of 60–89, 45–59, 30–44, and <30 respectively. Compared with eGFR≥90, the adjusted ORs for the subgroups with eGFR 60–89, 45–59, 30–45, and <30 were 0.95, 1.32, 1.78, and 2.19 respectively. Conclusion Acute kidney injury is a common complication in patients hospitalized with acute pyelonephritis. Preadmission impaired kidney function is a strong risk factor for development of acute kidney injury in pyelonephritis patients and more attention should be raised in prevention of pyelonephritis in patients with a low kidney function.

scholarly journals Contrast‐Induced Acute Kidney Injury in Patients Undergoing TAVI Compared With Coronary Interventions

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Gabriele Venturi ◽  
Michele Pighi ◽  
Gabriele Pesarini ◽  
Valeria Ferrero ◽  
Mattia Lunardi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Serum Creatinine ◽  
Contrast Medium ◽  
Kidney Function ◽  
Kidney Injury ◽  
Serum Creatinine Concentration ◽  
Creatinine Concentration ◽  
Emergency Procedures ◽  
The Impact

Background Differences in the impact of contrast medium on the development of contrast‐induced acute kidney injury (CI‐AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) or a coronary angiography/percutaneous coronary intervention (CA/PCI) have not been previously investigated. Methods and Results Patients treated with TAVI or elective CA/PCI were retrospectively analyzed in terms of baseline and procedural characteristics, including preprocedural and postprocedural kidney function. CI‐AKI was defined as a relative increase in serum creatinine concentration of at least 0.3 mg/dL within 72 hours of contrast‐medium administration compared with baseline. The incidence of CI‐AKI in the TAVI versus CA/PCI group was compared. After the exclusion of patients in dialysis and emergency procedures, 977 patients were analyzed; there were 489 patients who had undergone TAVI (50.1%) and 488 patients who had undergone CA/PCI (49.9%). Patients treated by TAVI were older, presenting a higher rate of anemia and chronic kidney disease ( P <0.001 for all comparisons). Consistently, they also had a significantly lower glomerular filtration rate and higher serum creatinine concentration ( P <0.001 for all). However, the occurrence of CI‐AKI was significantly lower in these patients compared with patients treated by a CA/PCI (6.7% versus 14.5%, P <0.001). At multivariate analysis, the TAVI procedure had an independent protective effect on CI‐AKI incidence among total population (odds ratio, 0.334; 95% CI, 0.193–0.579; P <0.001). This observation was confirmed after propensity score matching among 360 patients (180 by TAVI and 180 by CA/PCI; P =0.002). Conclusions CI‐AKI occurred less frequently in patients undergoing TAVI than in patients undergoing a CA/PCI, despite a worse‐risk profile. The impact of contrast administration on kidney function in patients who had undergone TAVI may be better tolerated because of the hemodynamic changes following aortic valve replacement.

scholarly journals The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Marisa Aparecida de Souza Oliveira ◽  
Thais Oliveira Claizoni dos Santos ◽  
Julio Cesar Martins Monte ◽  
Marcelo Costa Batista ◽  
Virgilio Gonçalves Pereira ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Function ◽  
Kidney Injury ◽  
Renal Outcomes ◽  
The Impact
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