title: Determining the incidence of drug-associated acute kidney injury in nursing home residents.
abstract: OBJECTIVE
  Although acute kidney injury (AKI) is well studied in the acute care setting, investigation of AKI in the nursing home (NH) setting is virtually nonexistent. The goal of this study was to determine the incidence of drug-associated AKI using the RIFLE (Risk, Injury, Failure, Loss of kidney function, or End-Stage kidney disease) criteria in NH residents.
  
  
  METHODS
  We conducted a retrospective study between February 9, 2012, and February 8, 2013, for all residents at 4 UPMC NHs located in southwest Pennsylvania. The TheraDoc™ Clinical Surveillance Software System, which monitors laboratory and medication data and fires alerts when patients have a sufficient increase in serum creatinine, was used for automated case detection. An increase in serum creatinine in the presence of an active medication order identified to potentially cause AKI triggered an alert, and drug-associated AKI was staged according to the RIFLE criteria. Data were analyzed by frequency and distribution of alert type by risk, injury, and failure.
  
  
  RESULTS
  Of the 249 residents who had a drug-associated AKI alert fire, 170 (68.3%) were women, and the mean age was 74.2 years. Using the total number of alerts (n = 668), the rate of drug-associated AKI was 0.41 events per 100 resident-days. Based on the RIFLE criteria, there were 191, 70, and 44 residents who were classified as AKI risk, injury, and failure, respectively. The most common medication classes included in the AKI alerts were diuretics, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs), and antibiotics.
  
  
  CONCLUSIONS
  Drug-associated AKI was a common cause of potential adverse drug events. The vast majority of cases were related to the use of diuretics, ACEIs/ARBs, and antibiotics. Future studies are needed to better understand patient, provider, and facility risk factors, as well as strategies to enhance the detection and management of drug-associated AKI in the NH.
authors.affiliation: Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: handler@pitt.edu.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Handler
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Pui Wen
authors.initials: PW
authors.lastname: Cheung
authors.affiliation: Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA; Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Culley
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.affiliation: Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Pharmacy and Therapeutics, Biomedical Informatics and Critical Care Medicine, School of Pharmacy and Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Kane-Gill
authors.affiliation: Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Geriatric Pharmaceutical Outcomes and Geroinformatics Research & Training Program, University of Pittsburgh, Pittsburgh, PA; Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes; D010414:Pennsylvania / Q000453:epidemiology; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012984:Software
chemical_list: D003404:Creatinine
keywords: Nursing homes; acute kidney injury; adverse drug events; clinical decision support systems