Expert Consensus on the Nephrotoxic Potential of 195 Medications in the Non-intensive Care Setting: A Modified Delphi Method

Britney A. Stottlemyer, Kaleab Z. Abebe, Paul M. Palevsky, Linda Fried, Ivonne H. Schulman, Chirag R. Parikh, Emilio Poggio, Edward D. Siew, Orlando M. Gutierrez, Edward Horwitz, Matthew R. Weir, F. Perry Wilson and Sandra L. Kane-Gill ()
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Britney A. Stottlemyer: University of Pittsburgh School of Pharmacy
Kaleab Z. Abebe: University of Pittsburgh School of Medicine
Paul M. Palevsky: University of Pittsburgh School of Medicine
Linda Fried: University of Pittsburgh School of Medicine
Ivonne H. Schulman: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)
Chirag R. Parikh: Johns Hopkins School of Medicine
Emilio Poggio: Glickman Urological and Kidney Institute, Cleveland Clinic
Edward D. Siew: Tennessee Valley Health Systems (TVHS) Nashville Veterans Affairs Hospital
Orlando M. Gutierrez: University of Alabama at Birmingham
Edward Horwitz: MetroHealth
Matthew R. Weir: University of Maryland School of Medicine
F. Perry Wilson: Yale School of Medicine
Sandra L. Kane-Gill: University of Pittsburgh School of Pharmacy

Drug Safety, 2023, vol. 46, issue 7, No 6, 677-687

Abstract: Abstract Introduction Nephrotoxin exposure is significantly associated with acute kidney injury (AKI) development. A standardized list of nephrotoxic medications to surveil and their perceived nephrotoxic potential (NxP) does not exist for non-critically ill patients. Objective This study generated consensus on the nephrotoxic effect of 195 medications used in the non-intensive care setting. Methods Potentially nephrotoxic medications were identified through a comprehensive literature search, and 29 participants with nephrology or pharmacist expertise were identified. The primary outcome was NxP by consensus. Participants rated each drug on a scale of 0–3 (not nephrotoxic to definite nephrotoxicity). Group consensus was met if ≥ 75% of responses were one single rating or a combination of two consecutive ratings. If ≥ 50% of responses indicated “unknown” or not used in the non-intensive care setting, the medication was removed for consideration. Medications not meeting consensus for a given round were included in the subsequent round(s). Results A total of 191 medications were identified in the literature, with 4 medications added after the first round from participants’ recommendations. NxP index rating consensus after three rounds was: 14 (7.2%) no NxP in almost all situations (rating 0); 62 (31.8%) unlikely/possibly nephrotoxic (rating 0.5); 21 (10.8%) possibly nephrotoxic (rating 1); 49 (25.1%) possibly/probably nephrotoxic (rating 1.5); 2 (1.0%) probably nephrotoxic (rating 2); 8 (4.1%) probably/definite nephrotoxic (rating 2.5); 0 (0.0%) definitely nephrotoxic (rating 3); and 39 (20.0%) medications were removed from consideration. Conclusions NxP index rating provides clinical consensus on perceived nephrotoxic medications in the non-intensive care setting and homogeneity for future clinical evaluations and research.

Date: 2023
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DOI: 10.1007/s40264-023-01312-5

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