Nephrotoxins and acute kidney injury – The consensus of the Taiwan acute kidney injury Task Force
Journal
Journal of the Formosan Medical Association = Taiwan yi zhi
Journal Volume
121
Journal Issue
5
Pages
886
Date Issued
2022-05
Author(s)
Huang, Wei-Chun
Wang, Mei-Tzu
Lee, Kuo-Hua
Shao, Shih-Chieh
Chen, Chien-Hao
Su, Chien-Hao
Chen, Yih-Ting
Sung, Junne-Ming
Chen, Yung-Chang
Abstract
The Taiwan Acute Kidney Injury (AKI) Task Force conducted a review of data and developed a consensus regarding nephrotoxins and AKI. This consensus covers: (1) contrast-associated AKI; (2) drug-induced nephrotoxicity; (3) prevention of drug-associated AKI; (4) follow up after AKI; (5) re-initiation of medication after AKI. Strategies for the avoidance of contrast media related AKI, including peri-procedural hydration, sodium bicarbonate solutions, oral N-acetylcysteine, and iso-osmolar/low-osmolar non-ionic iodinated contrast media have been recommended, given the respective evidence levels. Regarding anticoagulants, both warfarin and new oral anticoagulants have potential nephrotoxicity, and dosage should be reduced if renal pathology exam proves renal injury. Recommended strategies to prevent drug related AKI have included assessment of 5R/(6R) reactions - risk, recognition, response, renal support, rehabilitation and (research), use of AKI alert system and computerized decision support. In terms of antibiotics-associated AKI, avoiding concomitant administration of vancomycin and piperacillin-tazobactam, monitoring vancomycin trough level, switching from vancomycin to teicoplanin in high-risk patients, and replacing conventional amphotericin B with lipid-based amphotericin B have been shown to reduce drug related AKI. With respect to non-steroidal anti-inflammatory drug associated AKI, it is recommended to use these drugs cautiously in the elderly and in patients receiving renin-angiotensin-aldosterone system inhibitors/diuretics triple combinations.
Subjects
Acute kidney injuries; Contrast; Nephrotoxicity
SDGs
Publisher
ELSEVIER TAIWAN
Type
review