title: Adverse drug events during AKI and its recovery.
abstract: OBJECTIVE
  The impact of AKI on adverse drug events and therapeutic failures and the medication errors leading to these events have not been well described.
  
  
  METHODS
  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.
authors.affiliation: Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA. zachary.l.cox@vanderbilt.edu
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Cox
authors.forename: Allison B
authors.initials: AB
authors.lastname: McCoy
authors.forename: Michael E
authors.initials: ME
authors.lastname: Matheny
authors.forename: Gautam
authors.initials: G
authors.lastname: Bhave
authors.forename: Neeraja B
authors.initials: NB
authors.lastname: Peterson
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
authors.forename: Julia
authors.initials: J
authors.lastname: Lewis
authors.forename: Ioana
authors.initials: I
authors.lastname: Danciu
authors.forename: Aihua
authors.initials: A
authors.lastname: Bian
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.forename: Erin B
authors.initials: EB
authors.lastname: Neal
authors.forename: Josh F
authors.initials: JF
authors.lastname: Peterson
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D054796:Drug Dosage Calculations; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D057970:Inappropriate Prescribing; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013714:Tennessee; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D015415:Biomarkers; D003404:Creatinine
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