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Drug management in acute kidney disease - Report of the Acute Disease Quality Initiative XVI meeting.

Abstract：

AIMS:To summarize and extend the main conclusions and recommendations relevant to drug management during acute kidney disease (AKD) as agreed at the 16th Acute Disease Quality Initiative (ADQI) consensus conference. METHODS:Using a modified Delphi method to achieve consensus, experts attending the 16th ADQI consensus conference reviewed and appraised the existing literature on drug management during AKD and identified recommendations for clinical practice and future research. The group focussed on drugs with one of the following characteristics: (i) predominant renal excretion; (ii) nephrotoxicity; (iii) potential to alter glomerular function; and (iv) presence of metabolites that are modified in AKD and may affect other organs. RESULTS:We recommend that medication reconciliation should occur at admission and discharge, at AKD diagnosis and change in AKD phase, and when the patient's condition changes. Strategies to avoid adverse drug reactions in AKD should seek to minimize adverse events from overdosing and nephrotoxicity and therapeutic failure from under-dosing or incorrect drug selection. Medication regimen assessment or introduction of medications during the AKD period should consider the nephrotoxic potential, altered renal and nonrenal elimination, the effects of toxic metabolites and drug interactions and altered pharmacodynamics in AKD. A dynamic monitoring plan including repeated serial assessment of clinical features, utilization of renal diagnostic tests and therapeutic drug monitoring should be used to guide medication regimen assessment. CONCLUSIONS:Drug management during different phases of AKD requires an individualized approach and frequent re-assessment. More research is needed to avoid drug associated harm and therapeutic failure.

journal_name

Br J Clin Pharmacol

journal_title

British journal of clinical pharmacology

authors

Ostermann M,Chawla LS,Forni LG,Kane-Gill SL,Kellum JA,Koyner J,Murray PT,Ronco C,Goldstein SL,ADQI 16 workgroup.

doi

10.1111/bcp.13449

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

396-403

issue

eissn

0306-5251

issn

1365-2125

journal_volume

pub_type

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Drug management in acute kidney disease - Report of the Acute Disease Quality Initiative XVI meeting.