>Vigilance Regarding Drug-Induced Acute Kidney Injury in Ambulatory Older Adults

摘要

Over the past decade, the incidence of acute kidney injury (AKI) in older adults has increased. It has been noted that one of the primary reasons is drug-induced nephrotoxicity, which is secondary to a combination of susceptibilities to kidney injury and the increased use of medications in the elderly population. Specific drug classes are associated with increased rates of kidney injury, including drugs that block the renin-angiotensin system, antimicrobials, and che-motherapeutic agents. Of concern, for this discussion in particular, are angiotensin-converting enzyme (ACE) inhibitors, angiotensin 11-receptor blockers (ARBs), nonsteroidal anti-inflammatory drugs (NSAIDs), and diuretics, which are highly prescribed drugs that are frequently administered together. Since treatment for established drug-induced kidney injury is limited—and supportive care is required—early recognition of nephrotoxicity is critical, as are preventative steps, when applicable. It is critical, therefore, to limit exposure to nephrotoxic drugs (TABLE 1) to decrease the incidence of AKI in the elderly patient. This column will focus on raising awareness of this important issue and provide resources to ultimately assist in mitigating the risk of community-acquired AKI.