Expert Consensus on the Nephrotoxic Potential of 195 Medications in the Non-intensive Care Setting: A Modified Delphi Method.
Expert Consensus on the Nephrotoxic Potential of 195 Medications in the Non-intensive Care Setting: A Modified Delphi Method.
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DOI：
10.1007/s40264-023-01312-5
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发表时间：
2023-07
期刊：
影响因子：
4.2
通讯作者：
Kane-Gill, Sandra L.
中科院分区：
文献类型：
--
作者：
Stottlemyer, Britney A.;Abebe, Kaleab Z.;Palevsky, Paul M.;Fried, Linda;Schulman, Ivonne H.;Parikh, Chirag R.;Poggio, Emilio;Siew, Edward D.;Gutierrez, Orlando M.;Horwitz, Edward;Weir, Matthew R.;Wilson, F. Perry;Kane-Gill, Sandra L.
肾毒素暴露与急性肾损伤（阿基）的发生显著相关。对于非危重患者，尚不存在监测肾毒性药物及其感知肾毒性潜力（NxP）的标准化列表。这项研究对非重症监护环境中使用的195种药物的肾毒性作用达成了共识。通过全面的文献检索确定了潜在的肾毒性药物，并确定了29名具有肾脏病学或药剂师专业知识的参与者。主要结局是一致同意的NxP。参与者对每种药物进行0-3级评分（无肾毒性至明确肾毒性）。如果≥ 75%的回答是一个单一评级或两个连续评级的组合，则满足组共识。如果≥ 50%的回答表示“未知”或未在非重症监护环境中使用，则考虑停用药物。不符合给定轮次共识的药物纳入后续轮次。在文献中共确定了191种药物，其中4种药物是在第一轮参与者推荐后添加的。三轮后NxP指数评级共识为：14（7.2%）几乎所有情况下均无NxP（评分0）; 62（31.8%）不太可能/可能肾毒性（评级0.5）; 21（10.8%）可能肾毒性（rating 1）; 49（25.1%）可能/很可能肾毒性（评级1.5）; 2（1.0%）可能肾毒性（评级2）; 8（4.1%）很可能/明确肾毒性（评级2.5）; 0（0.0%）明确肾毒性（评级3）; 39（20.0%）种药物从考虑中删除。NxP指数评级为未来的临床评价和研究提供了关于非重症监护环境中感知的肾毒性药物的临床共识和同质性。
Nephrotoxin exposure is significantly associated with acute kidney injury (AKI) development. A standardized list of nephrotoxic medications to surveil and their perceived nephrotoxic potential (NxP) does not exist for non-critically ill patients. This study generated consensus on the nephrotoxic effect of 195 medications used in the non-intensive care setting. Potentially nephrotoxic medications were identified through a comprehensive literature search, and 29 participants with nephrology or pharmacist expertise were identified. The primary outcome was NxP by consensus. Participants rated each drug on a scale of 0–3 (not nephrotoxic to definite nephrotoxicity). Group consensus was met if ≥ 75% of responses were one single rating or a combination of two consecutive ratings. If ≥ 50% of responses indicated “unknown” or not used in the non-intensive care setting, the medication was removed for consideration. Medications not meeting consensus for a given round were included in the subsequent round(s). A total of 191 medications were identified in the literature, with 4 medications added after the first round from participants’ recommendations. NxP index rating consensus after three rounds was: 14 (7.2%) no NxP in almost all situations (rating 0); 62 (31.8%) unlikely/possibly nephrotoxic (rating 0.5); 21 (10.8%) possibly nephrotoxic (rating 1); 49 (25.1%) possibly/probably nephrotoxic (rating 1.5); 2 (1.0%) probably nephrotoxic (rating 2); 8 (4.1%) probably/definite nephrotoxic (rating 2.5); 0 (0.0%) definitely nephrotoxic (rating 3); and 39 (20.0%) medications were removed from consideration. NxP index rating provides clinical consensus on perceived nephrotoxic medications in the non-intensive care setting and homogeneity for future clinical evaluations and research.
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影响因子：
4.2
作者：
Gray MP;Barreto EF;Schreier DJ;Kellum JA;Suh K;Kashani KB;Rule AD;Kane-Gill SL
通讯作者：
Kane-Gill SL
影响因子：
2.7
作者：
Soares DB;Mambrini JVM;Botelho GR;Girundi FF;Botoni FA;Martins MAP
通讯作者：
Martins MAP
影响因子：
6.3
作者：
Radcliff, Sue;Yue, Jirong;Beers, Mark H.
通讯作者：
Beers, Mark H.
影响因子：
19.6
作者：
Mehta RL;Awdishu L;Davenport A;Murray PT;Macedo E;Cerda J;Chakaravarthi R;Holden AL;Goldstein SL
通讯作者：
Goldstein SL
影响因子：
2.3
作者：
Bamoulid, Jamal;Philippot, Helene;Ducloux, Didier
通讯作者：
Ducloux, Didier