Brothers Todd N, Strock Jacob, LeMasters Traci J, Pawasauskas Jayne, Reed Ronald C, Al-Mamun Mohammad A
College of Pharmacy, The University of Rhode Island, Kingston, RI, USA.
Graduate School of Oceanography, The University of Rhode Island, Narragansett, RI, USA.
SAGE Open Med. 2022 May 26;10:20503121221099359. doi: 10.1177/20503121221099359. eCollection 2022.
Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage.
We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model.
Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I-III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant (-value < 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1-22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14-39.06) cohort when compared to the stage III cohort.
Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention.
急性肾损伤在危重症患者中很常见。然而，急性肾损伤的发病率、药物使用情况及预后的描述存在差异。我们开展了一项单中心回顾性队列研究，以检查危重症成年患者急性肾损伤的危险因素及相关因素，特别关注药物类别使用情况。
我们回顾了2020年2月1日至8月30日期间入住重症监护病房的所有成年患者的电子病历。急性肾损伤根据2012年《改善全球肾脏病预后》指南进行定义。纳入的数据包括人口统计学、合并症、症状、实验室参数、干预措施及预后。主要结局为急性肾损伤发病率。使用最小绝对收缩和选择算子回归模型来确定与急性肾损伤相关的危险因素。使用Cox回归模型分析包括急性肾损伤恢复情况和重症监护病房死亡率在内的次要结局。
在226例入院患者中，108例（47.8%）发生了急性肾损伤。37例（34.3%）、39例（36.1%）和32例患者（29.6%）分别被分类为急性肾损伤I - III期。在恢复和死亡队列中，镇痛药/镇静剂、抗感染药和静脉输液具有显著意义（P值<0.05）。IV - 液体电解质营养类药物（96.7%）、胃肠道药物（90.2%）和抗感染药（81.5%）与发生急性肾损伤的几率增加相关，比值比分别为：1.27、1.71和1.70。Cox回归分析显示，急性肾损伤III期的随时间变化的死亡风险显著增加，风险比为：4.72（95%置信区间：1 - 22.33）。在恢复队列中，与III期队列相比，I期队列急性肾损伤恢复时间显著更快，风险比为：9.14（95%置信区间：2.14 - 39.06）。
评估生命体征、实验室检查和药物使用数据可能有助于确定急性肾损伤的风险分层。特定药物类别的影响进一步影响发生急性肾损伤的风险，这使得检查药物治疗方案对于早期识别肾功能损害和预防的重要性凸显出来。
