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Drug management in acute kidney disease – Report of the Acute Disease Quality Initiative XVI meeting
Author(s) -
Ostermann Marlies,
Chawla Lakhmir S.,
Forni Lui G.,
KaneGill Sandra L.,
Kellum John A.,
Koyner Jay,
Murray Patrick T.,
Ronco Claudio,
Goldstein Stuart L.
Publication year - 2018
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.13449
Subject(s) - medicine , intensive care medicine , drug , nephrotoxicity , kidney disease , adverse effect , pharmacology , regimen , therapeutic drug monitoring , dosing , renal function , kidney
Aims To summarize and extend the main conclusions and recommendations relevant to drug management during acute kidney disease (AKD) as agreed at the 16 th Acute Disease Quality Initiative (ADQI) consensus conference. Methods Using a modified Delphi method to achieve consensus, experts attending the 16 th 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.

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