Adverse drug events during AKI and its recovery

Clin J Am Soc Nephrol. 2013 Jul;8(7):1070-8. doi: 10.2215/CJN.11921112. Epub 2013 Mar 28.


Background and objectives: The impact of AKI on adverse drug events and therapeutic failures and the medication errors leading to these events have not been well described.

Design, setting, participants, & measurements: A single-center observational study of 396 hospitalized patients with a minimum 0.5 mg/dl change in serum creatinine who were prescribed a nephrotoxic or renally eliminated medication was conducted. The population was stratified into two groups by the direction of their initial serum creatinine change: AKI and AKI recovery. Adverse drug events, potential adverse drug events, therapeutic failures, and potential therapeutic failures for 148 drugs and 46 outcomes were retrospectively measured. Events were classified for preventability and severity by expert adjudication. Multivariable analysis identified medication classes predisposing AKI patients to adverse drug events.

Results: Forty-three percent of patients experienced a potential adverse drug event, adverse drug event, therapeutic failure, or potential therapeutic failure; 66% of study events were preventable. Failure to adjust for kidney function (63%) and use of nephrotoxic medications during AKI (28%) were the most common potential adverse drug events. Worsening AKI and hypotension were the most common preventable adverse drug events. Most adverse drug events were considered serious (63%) or life-threatening (31%), with one fatal adverse drug event. Among AKI patients, administration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, antibiotics, and antithrombotics was most strongly associated with the development of an adverse drug event or potential adverse drug event.

Conclusions: Adverse drug events and potential therapeutic failures are common and frequently severe in patients with AKI exposed to nephrotoxic or renally eliminated medications.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / complications*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / therapy
  • Adult
  • Aged
  • Biomarkers / blood
  • Creatinine / blood
  • Drug Dosage Calculations
  • Drug-Related Side Effects and Adverse Reactions / diagnosis
  • Drug-Related Side Effects and Adverse Reactions / etiology*
  • Drug-Related Side Effects and Adverse Reactions / mortality
  • Drug-Related Side Effects and Adverse Reactions / prevention & control
  • Female
  • Glomerular Filtration Rate
  • Hospitalization
  • Humans
  • Hypotension / chemically induced
  • Inappropriate Prescribing
  • Kidney / metabolism
  • Kidney / physiopathology*
  • Linear Models
  • Logistic Models
  • Male
  • Medication Errors*
  • Middle Aged
  • Multivariate Analysis
  • Risk Factors
  • Tennessee
  • Time Factors
  • Treatment Failure


  • Biomarkers
  • Creatinine