Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.


Subscribe or Register

Existing user? Login

Renal disorders

Drug classes commonly implicated in causing kidney injury identified

Antibacterials and diuretics among the classes most frequently implicated, but disease also plays a role, says commentator.

different classes of drugs - polypharmacy


Several classes of drugs have been identified as causing kidney injury and polypharmacy is a particular risk for causing acute kidney problems

Researchers have identified the drug classes that are frequently implicated in causing acute kidney injury (AKI) after analysing adverse drug reactions (ADRs) in a French national pharmacovigilance database.

While there were no great surprises in the final list, the data highlight which drugs are linked with this potential adverse outcome, the researchers say.

The team from Amiens University Hospital looked at all ADRs in the database reported as acute renal disease and compared them with other drug reactions recorded in the same period. The selected ADRs were recorded in the database between 1 January 2015 and 31 December 2015.

Of 38,782 ADRs recorded in the database, they found 3.2% (or 1,254 patients) were acute kidney injury in patients who had a mean age of 69 years, they reported in the British Journal of Clinical Pharmacology[1] (online, 14 March 2017).

In all, 434 drugs were reported as being suspected – i.e. definitely or probably responsible – of causing acute kidney injury over the year studied and 68 of those were found to be associated with a significant relative risk.

The most frequently implicated drugs in the adverse events reported were systemic antibacterials (528 reports; 29.5%); diuretics (328 reports; 18.5%); drugs acting on the renin-angiotensin system (289 reports; 16.3%); antineoplastic agents (180 reports; 10.2%); and anti-inflammatory drugs (95 reports; 5.4%).

Gentamicin, eplerenone, candesartan, cisplatin and aciclovir had the highest relative risk of causing acute kidney injury.

Two-thirds of the cases involved two or more concomitantly administered drugs, the research found, which supports other studies showing that polypharmacy is a particular risk for causing acute kidney problems.

Of patients who had suffered acute kidney damage, 15% had needed renal replacement therapy, such as dialysis and kidney transplant and 4.6% died.

Most of the drug classes identified by the researchers were already known to be linked to potential kidney problems but the database “should raise physicians’ awareness of the compounds responsible for triggering this potentially life-threatening condition”, they write.

Prescribers need to be aware of the need for “highly responsive” monitoring with treatments where the chances of nephrotoxicity are significant, they added.

Commenting on the research, Oscar Della Pasqua, chair of clinical pharmacology and therapeutics at the school of pharmacy/school of life & medical sciences at University College London, says the study had a number of limitations.

“First, we need to be aware of the fact that the figures do not reflect the true incidence of the ADRs. The reporting odds ratio corresponds to the risk of spontaneous notification of an ADR. In addition, as the authors state, the data in the database on the patient’s medical history (including chronic kidney disease and diabetes) were sparse, which prevented them from analysing other risk factors possibly associated with AKI.”

He says this is important given the fact that the drugs included in the list are used to treat acute and chronic diseases, some of which can also promote the occurrence of AKI (for example, heart failure, hypertension, diabetes, infectious diseases and cancer).

“This confounding can lead to biased estimates of the actual risk,” he says.

He also points out that the authors do not consider inter-individual differences (variability) in pharmacokinetics as a potential determinant of ADRs.

“They conclude therefore that withdrawal of nephrotoxic treatments should be considered. Such a recommendation needs to be revisited, as some drugs can be critical for the patient, for example, stopping antibiotics can lead to life-threatening complications. Instead, the use of therapeutic drug monitoring as well as the development of dosing algorithms may offer concrete opportunities for treatment personalization and ultimately reduce the incidence of AKI for these drugs.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20202504

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Introduction to Renal Therapeutics

    Introduction to Renal Therapeutics

    Introduction to Renal Therapeutics covers all aspects of drug use in renal failure. Shows the role of the pharmacist in patient care for chronic kidney disease.

    £37.00Buy now
  • Disease Management

    Disease Management

    Disease Management covers the diseases commonly encountered in primary care by system, with common therapeutic issues. Includes case studies and self-assessment sections.

    £52.00Buy now
  • Drugs and the Liver

    Drugs and the Liver

    Drugs and the Liver assists practitioners in making pragmatic choices for their patients. It enables you to assess liver function and covers the principles of drug use in liver disease.

    £37.00Buy now
  • Chronotherapeutics


    Chronotherapeutics discusses the pharmaceutical and therapeutic implications associated with biological clocks in humans.

    £37.00Buy now
  • Minor Illness or Major Disease

    Minor Illness or Major Disease

    This established textbook helps you differentiate between minor illnesses which can be safely managed in the pharmacy, and major diseases.

    £42.00Buy now
  • FASTtrack: Pharmaceutics - Drug Delivery and Targeting

    FASTtrack: Pharmaceutics - Drug Delivery and Targeting

    Pharmaceutics: Drug Delivery and Targeting systematically reviews important concepts for drug delivery systems and targeting of drugs.

    £24.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Supplementary images

  • different classes of drugs - polypharmacy

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.