Journal article
Evidence-based development of a nephrotoxic medication list to screen for acute kidney injury risk in hospitalized children
American journal of health-system pharmacy, Vol.76(22), pp.1869-1874
10/30/2019
DOI: 10.1093/ajhp/zxz203
PMCID: PMC7170726
PMID: 31665764
Abstract
Medications are commonly associated with acute kidney injury (AKI). However, in both clinical practice and research, consideration of specific medications as nephrotoxic varies widely. The Nephrotoxic Injury Negated by Just-in-time Action quality improvement collaborative was formed to focus on prevention or reduction of nephrotoxic medication-associated AKI in noncritically ill hospitalized children. However, there were discrepancies among institutions as to which medications should be considered nephrotoxic. The collaborative convened a Nephrotoxic Medication (NTMx) Subcommittee to develop a consensus for the classification of nephrotoxic medications.
The NTMx Subcommittee initially included pediatric nephrologists, a pharmacist, and a pediatric intensivist. The committee reviewed NTMx lists from the collaborative and identified changes from the initial NTMx list. The NTMx Subcommittee conducted a literature review of the disputed medications and assigned an evidence grade based on the reported association with nephrotoxicity and the quality of the data. The association between medication exposure and AKI was also determined using administrative data from the Pediatric Health Information Systems database. The NTMx Subcommittee then came to a majority consensus regarding which medications should be included on the list. The subcommittee's recommendations were presented to the larger collaborative for approval, and consensus was achieved. The list continues to be reviewed and updated annually.
Formation of a multicenter quality-improvement initiative exposed current limitations as to which medications are considered nephrotoxic in clinical and research settings and presented an opportunity to approach this problem using an evidence-based process. A consensus definition of nephrotoxic-medication exposure was achieved.
Details
- Title: Subtitle
- Evidence-based development of a nephrotoxic medication list to screen for acute kidney injury risk in hospitalized children
- Creators
- Elizabeth Goswami - Johns Hopkins HospitalRichard K Ogden - Children's Mercy HospitalWilliam E Bennett - Indiana UniversityStuart L Goldstein - Cincinnati Children's Hospital Medical CenterRichard Hackbarth - Helen DeVos Children's HospitalMichael J G Somers - Boston Children's HospitalKaryn Yonekawa - University of WashingtonJason Misurac - University of Iowa
- Resource Type
- Journal article
- Publication Details
- American journal of health-system pharmacy, Vol.76(22), pp.1869-1874
- DOI
- 10.1093/ajhp/zxz203
- PMID
- 31665764
- PMCID
- PMC7170726
- ISSN
- 1079-2082
- eISSN
- 1535-2900
- Grant note
- R18 HS023763 / AHRQ HHS
- Language
- English
- Date published
- 10/30/2019
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
- Record Identifier
- 9984353935002771
Metrics
15 Record Views