Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study.
Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study.
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作者：
Soares DB;Mambrini JVM;Botelho GR;Girundi FF;Botoni FA;Martins MAP
急性肾损伤（阿基）与发病率、死亡率和医疗保健费用的显著增加相关。在重症监护病房（ICU）中，阿基通常是多因素的，经常涉及不同的因素，如血容量不足、败血症和使用肾毒性药物。我们的目的是调查药物治疗和其他因素与发展的阿基在巴西公立医院。这是一项涉及三级医院ICU重症患者的横断面研究。在ICU住院期间，收集了连续血清肌酐（SCr）水平、肾小球滤过率（GFR）和尿量的所有数据。主要结局是根据急性肾损伤网络（AKIN）标准评估的阿基发生率。社会人口统计学、临床数据和药物治疗被视为协变量。使用logistic回归评估与阿基相关的因素。共有122名参与者参与了这项研究。中位年龄为46.0岁（四分位距，IQ = 29.0-69.0），男性占多数（58.2%）。整个ICU住院期间的平均处方药物数量为22.0 ± 9.4。潜在肾毒性药物的数量范围为每例患者2至24种。共有29例（23.8%）ICU患者发生阿基。在AKI组中，患者年龄较大，入院时急性生理学和慢性健康评估II（APACHE II）评分较高，镇静、机械通气和感染发生率较高。阿基组一般使用更多药物，特别是血管活性药物。与未发生阿基的患者相比，发生AKI的患者往往在ICU停留时间较长，并且活着出院的概率较低。logistic回归模型调整显示，药物数量（OR 1.15; 95% CI [1.05-1.27]）是本研究中与阿基相关的唯一因素。这种关联与药物肾毒性无关。重症监护的特点是其复杂性，结合了不稳定的病人，严重的疾病，高密度的医疗干预和药物使用。我们发现阿基的典型危险因素在双变量分析中显示出统计学相关性。药物治疗在内科ICU发生阿基中的作用加强了对预防策略的需求，重点是早期识别肾功能不全和药物治疗干预。这些行动将有助于提高病人护理质量，并确保在药物安全方面取得进展。
Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital. This is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (SCr) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression. Overall, 122 participants were included in the study. Median age was 46.0 (interquartile range, IQ = 29.0–69.0) years, with a predominance of men (58.2%). Mean number of prescribed drugs throughout ICU stay was 22.0 ± 9.4. The number of potentially nephrotoxic drugs ranged from two to 24 per patient. A total of 29 (23.8%) ICU patients developed AKI. In the AKI-group, patients were older and showed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, higher rates of sedation, mechanical ventilation, and infection. More drugs in general and specifically more vasoactive drugs were prescribed for AKI group. Patients who developed AKI tended to have extended stays in the ICU and a lower probability of being discharged alive than patients with no AKI development. Model adjustments of logistic regression showed that the number of medications (OR 1.15; 95% CI [1.05–1.27]) was the only factor associated with AKI in this study. This association was independent of drug nephrotoxicity. Intensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found that typical risk factors for AKI showed statistical association on bivariate analysis. The contribution of drug therapy in the occurrence of AKI in medical ICUs reinforces the need for prevention strategies focused on early recognition of renal dysfunction and interventions in drug therapy. These actions would help improve the quality of patient care and ensure progress towards medication safety.
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影响因子：
--
作者：
Bursac, Zoran;Gauss, C Heath;Williams, David Keith;Hosmer, David W
通讯作者：
Hosmer, David W
影响因子：
4.9
作者：
Mostardeiro, Marcelo M.;Pereira, Carlos A. P.;Camargo, Luis Fernando A.
通讯作者：
Camargo, Luis Fernando A.
DOI：
10.1590/s0100-879x2006001000010
发表时间：
2006-10-01
影响因子：
2.3
作者：
Mataloun, S.E.;Machado, F.R.;Amaral, J.L.G.
通讯作者：
Amaral, J.L.G.
影响因子：
0.9
作者：
Bernieh, B;Al Hakim, M;Dastoor, H
通讯作者：
Dastoor, H
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)