Acute Renal Failure in Patients on Diuretics and/or NSAID, COX‐2 inhibitors, ACEI, ARA

Aim To review acute renal failure in patients on one or more target drugs – diuretics, non‐steroidal anti‐inflammatory drugs (NSAID), cyclo‐oxygenase‐2 (COX‐2) inhibitors, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (ARA). Method Retrospective review of drug charts of patients admitted to hospital with acute renal failure from 2003 to 2005. Patients taking one or more of the target drugs prior to admission were identified. Data were collected on patient demographics, target drugs, other factors contributing to acute renal failure, medical history, baseline and peak creatinine concentration, and clinical outcome. The baseline and lowest estimated glomerular filtration rate (eGFR) were calculated. Results Of the 289 patients admitted with acute renal failure, 108 (37%) were taking one or more of the target drugs. The mean age was 73 years and 84 patients (79%) had a baseline eGFR of = 60 mL/min. There was a marked decline in kidney function from a mean baseline eGFR of 50 mL/min to 17 mL/min (60% decline). 44% of patients were dehydrated, 12% were septic and 60% had more than 4 comorbid diseases. Only 6 patients were on more than 3 target drugs. The decline in eGFR exceeded 50% with each drug/drug combination and except for ACEI and ARA (withheld in 50% of cases) other drugs/drug combinations were withheld in most patients. Acute renal failure was reversible after treatment of the underlying illness and withdrawal of the target drugs in the majority of patients. Conclusion Over a third of patients with acute renal failure were taking diuretics, NSAID/COX‐2 inhibitors, ACEI/ARA, which may have played a causal or contributory role in the decline in their renal function. Other risk factors for developing acute renal failure included dehydration, sepsis, multiple comorbidities and older age.