ICU Clinical Pharmacists: Helping Preventing Drug-Induced Acute Kidney Injury

Approximately 25% of patients treated in the intensive care unit (ICU) develop an acute kidney injury (AKI). An AKI is a sudden, brief period of kidney damage resulting in the accumulation of waste products in the blood, making it hard for the kidneys to maintain fluid balance within the body.¹

Even if the kidneys recover, an AKI can result in lasting damage to both the kidneys and cardiovascular system.²

In a study published in the November 2022 issue of the Journal of Clinical Pharmacy and Therapeutics, a team of researchers aimed to show how clinical pharmacist involvement in the ICU team could influence the incidence, stages, and treatment of AKI. They found that AKI was less common when a pharmacist was part of the ICU interdisciplinary team and kidney function was restored faster after an AKI.

Drug-induced AKI accounts for a significant proportion of cases of the condition that are encountered clinically. Inappropriate drug dosing, drug plasma levels above the maximum therapeutic concentration, unnecessary use of nephrotoxic drugs, and ignoring drug-drug interactions can all lead to a drug-induced AKI.

The researchers found significant and positive relationships between AKI and antibiotics, anesthetics, and cardiovascular system drugs. Specifically, patients in the ICU who were taking ampicillin-sulbactam, ceftriaxone, clarithromycin, colistin, dexketoprofen, midazolam, and vancomycin were at an increased risk for an AKI.

The most common comorbid diseases in patients treated in the ICU were hypertension, diabetes mellitus (DM), coronary artery disease, congestive heart failure (CHF), and cancer, respectively. Consistent with the findings of other studies, researchers found that of those comorbid conditions, patients with DM, CHF and cancer comorbidities were at an increased risk of developing an AKI.

Serum creatinine (SCr) levels impact morbidity and mortality of patients admitted to the ICU. A lower SCr value was seen when a pharmacist was involved in the ICU care team, indicating that the knowledge of clinical pharmacists helps protect kidney function and prevent the development of AKI in ICU patients.

Conclusion

Clinical pharmacists are an essential component of ICU care teams. The consultation services that they provide include the identification, solution, and prevention of drug-related problems. These services can minimize the incidence of an AKI and improve therapeutic outcomes of patients in the ICU.

References

1. Acute kidney injury (AKI). National Kidney Foundation. https://www.kidney.org/atoz/content/AcuteKidneyInjury. Published August 11, 2022. Accessed January 5, 2023.
2. X S. Drug discovery offers potential treatment for common kidney disease. Medical Xpress - medical research advances and health news. https://medicalxpress.com/news/2022-12-drug-discovery-potential-treatment-common.html. Published December 14, 2022. Accessed January 5, 2023.
3. Polat EC, Koc A, Demirkan K. The role of the clinical pharmacist in the prevention of drug‐induced acute kidney injury in the Intensive Care Unit. Journal of Clinical Pharmacy and Therapeutics. 2022;47(12):2287-2294. doi:10.1111/jcpt.13811

About the Author

Kirsten Werner is a 2023 PharmD candidate at the University of Connecticut.