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

Ostermann, M., Chawla, L.S., Forni, Lui G., Kane-Gill, S.L., Kellum, J.A., Koyner, J., Murray, P.T., Ronco, C. and Goldstein, S.L. (2018) Drug management in acute kidney disease - Report of the Acute Disease Quality Initiative XVI meeting British Journal of Clinical Pharmacology, 84 (2). pp. 396-403.

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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 t he 16thADQI 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 non renal 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.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Ostermann, M.
Chawla, L.S.
Forni, Lui G.l.forni@surrey.ac.uk
Kane-Gill, S.L.
Kellum, J.A.
Koyner, J.
Murray, P.T.
Ronco, C.
Goldstein, S.L.
Date : February 2018
DOI : 10.1111/bcp.13449
Copyright Disclaimer : Copyright 2017 The British Pharmacological Society
Uncontrolled Keywords : Acute kidney disease; Acute kidney injury; Drug management; Drugs
Depositing User : Diane Maxfield
Date Deposited : 25 Oct 2019 09:23
Last Modified : 25 Oct 2019 09:23
URI: http://epubs.surrey.ac.uk/id/eprint/852717

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