title: Drug Class Combination-Associated Acute Kidney Injury.
abstract: To evaluate the quality of available evidence of drug class combinations and their association with the development of acute kidney injury (AKI).
  
  
  
  A search of MEDLINE and Embase databases was completed using the following terms: "risk factor AND (acute kidney injury or acute kidney failure) AND (drug or medication)."
  
  
  
  Inclusion criteria were the following: English language, full-text availability, and at least 1 drug-combination. Each citation was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. The literature was evaluated using the quality of evidence component of GRADE. No standardized definition of AKI was applied throughout..
  
  
  
  Out of 2139 total citations, 151 were assessed for full-text review, with 121 citations (6%) meeting inclusion criteria, producing76 unique drug class combinations. Overall, 56 combinations (73.7%) were considered very low quality; 12 (15.8%) were considered low quality. There were 8 (10.5%) of moderate quality, and no combination was considered high quality. 58 (76%) combinations that had a single citation,with a mean of 1.6 citations per drug class combination. The combination of nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics was reported in 10 citations, the largest number of citations.
  
  
  
  Our study demonstrates a lack of well-designed studies addressing drug class combination-associated AKI. The combination of NSAIDs and diuretics with or without additional renin-angiotensin aldosterone agents had the strongest level of evidence. Despite limitations, the information included in this review may result in additional scrutiny about combining certain individual nephrotoxic drugs.
authors.affiliation: 1 UPMC Presbyterian Hospital, PA, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Rivosecchi
authors.affiliation: 2 University of Pittsburgh School of Medicine, PA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: 3 University of Texas College of Pharmacy, TX, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Dasta
authors.affiliation: 4 University of Maryland Medical Center, MD, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Armahizer
authors.affiliation: 5 Wilkes University Nesbitt College of Pharmacy, PA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Bolesta
authors.affiliation: 6 Banner Health-University Medical Center, Phoenix, AZ, USA.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Buckley
authors.affiliation: 7 New York-Presbyterian Hospital, NY, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Dzierba
authors.affiliation: 8 Mayo Clinic, MN, USA.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Frazee
authors.affiliation: 9 University of Pittsburgh School of Pharmacy, PA, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Johnson
authors.affiliation: 1 UPMC Presbyterian Hospital, PA, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kim
authors.affiliation: 2 University of Pittsburgh School of Medicine, PA, USA.
authors.forename: Raghavan
authors.initials: R
authors.lastname: Murugan
authors.affiliation: 9 University of Pittsburgh School of Pharmacy, PA, USA.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Smithburger
authors.affiliation: 10 Brigham and Women's Hospital, MA, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: 2 University of Pittsburgh School of Medicine, PA, USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Kane Gill
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006801:Humans
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: adverse drug reactions; kidney failure; nephrology; nephrotoxicity; renal failure