Consensus Obtained for the Nephrotoxic Potential of 167 Drugs in Adult Critically Ill Patients Using a Modified Delphi Method

Matthew P. Gray, Erin F. Barreto, Diana J. Schreier, John A. Kellum, Kangho Suh, Kianoush B. Kashani, Andrew D. Rule and Sandra L. Kane-Gill ()
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Matthew P. Gray: University of Pittsburgh
Erin F. Barreto: Mayo Clinic
Diana J. Schreier: Mayo Clinic
John A. Kellum: University of Pittsburgh School of Medicine
Kangho Suh: University of Pittsburgh
Kianoush B. Kashani: Mayo Clinic
Andrew D. Rule: Mayo Clinic
Sandra L. Kane-Gill: University of Pittsburgh

Drug Safety, 2022, vol. 45, issue 4, No 8, 389-398

Abstract: Abstract Introduction The approach to evaluating nephrotoxins in studies of drug-associated acute kidney injury varies. Some studies use a list of under ten drugs for evaluation whereas others include over 100 drugs. Drugs are typically assigned a binary classification, nephrotoxic or not nephrotoxic. This oversimplifies the nephrotoxic potential of the drugs under investigation. Objective This study aimed to assign a nephrotoxin potential for 167 drugs used in the adult critical care setting. Methods A three-round, international, interdisciplinary, web-based modified-Delphi study was used to evaluate nephrotoxins used in adult critically ill patients. Twenty-four international experienced clinicians were identified through the Acute Disease Quality Initiative group and professional affiliations. Included individuals represented the fields of intensive care, nephrology, and pharmacy. One hundred and fifty-nine medications were identified from the literature, with eight additional medications added after the first round, for a total of 167 medications. The primary outcome was consensus achieved for nephrotoxicity ratings. Scores were evaluated each round to determine if a consensus was met. Results Our nephrotoxin potential index rating indicated that 20 drugs were nephrotoxicity probable or probable/definite per consensus. Nephrotoxic potential was assessed based on the standard use of medications in intensive care and the following consensus scores: 0 = no nephrotoxic potential, 1 = possible nephrotoxic potential, 2 = probable nephrotoxic potential, 3 = definite nephrotoxic potential. Conclusions The nephrotoxin potential index rating allows for prioritization of targeted drugs with greater nephrotoxic potential for institutional nephrotoxin stewardship programs. Furthermore, the nephrotoxin potential index rating provides homogeneity for research and guidance on detailed assessments by severity for each drug.

Date: 2022
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DOI: 10.1007/s40264-022-01173-4

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