P32
PATIENT ADVICE REGARDING PRESCRIBED MEDICATIONS DURING
INTERCURRENT ILLNESS TO PREVENT ACUTE KIDNEY INJURY
Lloyd O, McGuinness J, Hind J, Muniraju T
Renal Unit, Dumfries & Galloway Royal Infirmary
INTRODUCTION: Acute kidney injury (AKI) is common, dangerous, and expensive.
Previous studies have revealed nephrotoxic medications to be a contributing factor in 16-26% of
cases of AKI. Increasing numbers of patients are prescribed potentially nephrotoxic medications
but there is currently no national consensus on what advice to give patients regarding these
medications during intercurrent illness to prevent AKI. We reviewed our local AKI
epidemiology, the role of prescribed medications, and what advice we were providing our
inpatients on what to do with angiotensin converting enzyme inhibitors (ACEi), angiotensin
receptor blockers (ARBs), diuretics and non steroidal anti inflammatory drugs (NSAIDs) during
intercurrent illnesses such as diarrhoea and vomiting.
METHODS: Patients admitted with a primary diagnosis of AKI on discharge from January
2011 to December 2012 were identified by our local coding office. A retrospective case note
and electronic patient record review was subsequently performed to extract baseline
characteristics, aetiology, severity of AKI (AKIN criteria), outcome of prescribed medications,
follow-up eGFR and whether documented advice was given to the patients regarding potentially
nephrotoxic prescribed medications.
RESULTS: Data was extracted from 142 patient records coded with a diagnosis of AKI. There
were 89 male and 53 female patients with a median age of 76 years. The frequency of different
AKI stages, and use of renal replacement therapy is shown below (table 1). 44% of the patients
admitted with AKI were taking either ACEi or ARBs, 57% were taking diuretics, and 8% were
taking NSAIDs. Only 10 records (7%) had documented advice regarding potential nephrotoxins
prior to discharge.
n (%)
AKI STAGE 1
54 (38)
2
25 (18)
3
63 (44)
RRT
9 (6)
Table 1
CONCLUSION: The local AKI epidemiology regarding aetiology is in keeping with previous
studies of AKI. Incidence and severity of AKI is significantly increased in patients taking
certain prescribed medications during intercurrent illness. Written documentation explaining to
patients what to do with potential nephrotoxic medications during intercurrent illness, such as
diarrhoea and vomiting, is essential to prevent AKI. There is an urgent need for national
consensus in this area.