Utilizing Nephrotoxic Medications and Starting Renal Replacement Therapies in Acute Settings: A Single-Center Retrospective Study

Acute kidney injury (AKI) is common in hospitalized patients, and it is associated with higher mortality and morbidity. Drug-induced kidney disease (DIKD) accounts for approximately 8-60% of hospitalized patients and 14-28% in intensive care unit patients. Nephrotoxic agents are one of the possible causes of AKI in acute settings. Most previous studies have identified the relationship between utilizing nephrotoxic medications and the rate of AKI. Limited literature has addressed the relationship between nephrotoxic medications and the need to start renal replacement therapy (RRT). The main aim of this study was to assess the correlation between the use of nephrotoxic medications and the initiation of RRT in acute settings. This retrospective cohort study included adult hospitalized patients older than 18 years at a tertiary academic center who had received one of the following medications for more than 24 hours: angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors (ACEIs), thiazide, amphotericin B, aminoglycoside, vancomycin, piperacillin/tazobactam, colistin, acyclovir, cisplatin, and methotrexate. In total, 86 patients were included in this study; 25 (29%) developed AKI, and only 15 (17.4%) required RRT. Piperacillin/tazobactam (
P
= 0.01), vancomycin (
P
= 0.02), and ACEIs (P = 0.02) were the most common nephrotoxic drugs prescribed in patients who required RRT. Hospitalized patients receiving vancomycin, piperacillin/tazobactam, or ACEIs had higher chances of starting RRT. Identifying patients at risk of drug-induced kidney disease is crucial to prevent the need for RRT.