Kashani, Kianoush

The objective of this project was to develop a standardized list of renally eliminated and potentially nephrotoxic drugs that will help inform initiatives to improve medication safety. Several available lists of medications from the published literature including original research articles and reviews, and from regulatory agencies, tertiary references, and clinical decision support systems were compiled, consolidated, and compared. Only systemically administered medications were included. Medication combinations were included if at least 1 active ingredient was considered renally dosed or potentially nephrotoxic. The medication list was reviewed for completeness and clinical appropriateness by a multidisciplinary team of individuals with expertise in critical care, nephrology, and pharmacy. An initial list of renally dosed and nephrotoxic drugs was created. After reconciliation and consensus from clinical experts, a standardized list of 681 drugs is proposed. The proposed evidence-based standardized list of renally dosed and potentially nephrotoxic drugs will be useful to harmonize epidemiologic and medication quality improvement studies. In addition, the list can be used for clinical purposes with surveillance in nephrotoxin stewardship programs. We suggest an iterative re-evaluation of the list with emerging literature and new medications on an approximately annual basis.

Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit (ICU), and it is known as an independent factor for adverse outcomes like increased length of hospital stay, the development of chronic kidney disease (CKD), and increased mortality with the associated high cost to healthcare systems. The use of AKI biomarkers and new tools such as point-of-care ultrasonography (POCUS) to perform a hemodynamic and volume status assessment has made it more feasible to detect or predict kidney damage in a very accurate way, thereby avoiding the progression of AKI. The design and implementation of a nephrology rapid response team (NRRT) should be considered to improve patient outcomes and healthcare costs. In this paper, we provide an overview of the implementation of an NRRT.