My Thoughts Re Rehab Programme Pilot

2125PATIENT ADVICE REGARDING PRESCRIBED MEDICATIONS DURING INTERCURRENT ILLNESS TO PREVENT ACUTE KIDNEY INJURY

Lloyd O, McGuinness J, Hind J, Muniraju T Renal Unit, Dumfries & Galloway Royal Infirmary

INTRODUCTION: Acute kidney injury (AKI) is common, dangerous, and expensive. Previous studies have revealed nephrotoxic medications to be a contributing factor in 16-26% of cases of AKI. Increasing numbers of patients are prescribed potentially nephrotoxic medications but there is currently no national consensus on what advice to give patients regarding these medications during intercurrent illness to prevent AKI. We reviewed our local AKI epidemiology, the role of prescribed medications, and what advice we were providing our inpatients on what to do with angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), diuretics and non steroidal anti inflammatory drugs (NSAIDs) during intercurrent illnesses such as diarrhoea and vomiting.

METHODS: Patients admitted with a primary diagnosis of AKI on discharge from January 2011 to December 2012 were identified by our local coding office. A retrospective case note and electronic patient record review was subsequently performed to extract baseline characteristics, aetiology, severity of AKI (AKIN criteria), outcome of prescribed medications, follow-up eGFR and whether documented advice was given to the patients regarding potentially nephrotoxic prescribed medications.

RESULTS: Data was extracted from 142 patient records coded with a diagnosis of AKI. There were 89 male and 53 female patients with a median age of 76 years. The frequency of different AKI stages, and use of renal replacement therapy is shown below (table 1). 44% of the patients admitted with AKI were taking either ACEi or ARBs, 57% were taking diuretics, and 8% were taking NSAIDs. Only 10 records (7%) had documented advice regarding potential nephrotoxins prior to discharge.

n (%) AKI STAGE 1 54 (38) 2 25 (18) 3 63 (44) RRT 9 (6)

Table 1

CONCLUSION: The local AKI epidemiology regarding aetiology is in keeping with previous studies of AKI. Incidence and severity of AKI is significantly increased in patients taking certain prescribed medications during intercurrent illness. Written documentation explaining to patients what to do with potential nephrotoxic medications during intercurrent illness, such as diarrhoea and vomiting, is essential to prevent AKI. There is an urgent need for national consensus in this area.