title: Drug-Induced Nephrotoxicity and Dose Adjustment Recommendations: Agreement Among Four Drug Information Sources.
abstract: : Hospitalized patients require the use of a variety of drugs, many of which individually or in combination have the potential to cause kidney damage. The use of potentially nephrotoxic drugs is often unavoidable, and the need for dose adjustment should be evaluated. This study is aimed at assessing concordance in information on drug-induced nephrotoxicity and dose adjustment recommendations by comparing four drug information sources (DRUGDEX(®), UpToDate(®), Medscape(®) and the Brazilian Therapeutic Formulary) using the formulary of a Brazilian public hospital. A total of 218 drugs were investigated. The global Fleiss' kappa coefficient was 0.265 for nephrotoxicity (p < 0.001; CI 95%, 0.211-0.319) and 0.346 for recommendations (p < 0.001; CI 95%, 0.292-0.401), indicating fair concordance among the sources. Anti-infectives and anti-hypertensives were the main drugs cited as nephrotoxic by the different sources. There were no clear definitions for qualitative data or quantitative values for dose adjustments among the four information sources. There was no advice for dosing for a large number of the drugs in the international databases. The National Therapeutic Formulary offered imprecise dose adjustment recommendations for many nephrotoxic drugs. Discrepancies among information sources may have a clinical impact on patient care and contribute to drug-related morbidity and mortality.
authors.affiliation: Maternidade Hospital Octaviano Neves, Rua Ceará, 186, Bairro Santa Efigênia, Belo Horizonte CEP 30150-310, MG, Brazil. milleninhadb@hotmail.com.
authors.forename: Millena Drumond
authors.initials: MD
authors.lastname: Bicalho
authors.affiliation: Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, CEP 31270-901, MG, Brazil. danielly_botelho@yahoo.com.br.
authors.forename: Danielly Botelho
authors.initials: DB
authors.lastname: Soares
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, CEP 30130-100, MG, Brazil. fabotoni@gmail.com.|Hospital Risoleta Tolentino Neves, R. das Gabirobas, Bairro Vila Cloris, Belo Horizonte, 31744-012, MG, Brazil. fabotoni@gmail.com.
authors.forename: Fernando Antonio
authors.initials: FA
authors.lastname: Botoni
authors.affiliation: Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, CEP 31270-901, MG, Brazil. amreis@outlook.com.|Hospital Risoleta Tolentino Neves, R. das Gabirobas, Bairro Vila Cloris, Belo Horizonte, 31744-012, MG, Brazil. amreis@outlook.com.
authors.forename: Adriano Max Moreira
authors.initials: AM
authors.lastname: Reis
authors.affiliation: Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, CEP 31270-901, MG, Brazil. auxiliadorapmartins@hotmail.com.|Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, CEP 30130-100, MG, Brazil. auxiliadorapmartins@hotmail.com.|Hospital Risoleta Tolentino Neves, R. das Gabirobas, Bairro Vila Cloris, Belo Horizonte, 31744-012, MG, Brazil. auxiliadorapmartins@hotmail.com.
authors.forename: Maria Auxiliadora Parreiras
authors.initials: MA
authors.lastname: Martins
mesh_terms: D000890:Anti-Infective Agents / Q000633:toxicity*; D000959:Antihypertensive Agents / Q000633:toxicity*; D001938:Brazil; D054796:Drug Dosage Calculations; D004346:Drug Information Services / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male
chemical_list: D000890:Anti-Infective Agents; D000959:Antihypertensive Agents
keywords: drug information; drug toxicity; kidney insufficiency