Insuficiencia renal aguda relacionada con fármacos en pacientes hospitalizados

Student thesis: Doctoral thesis


Background Acute renal failure (ARF) is a frequent and serious complication during hospitalization, but the incidence of ARF depends on the definition used and the population studied. ARF affect 5% to 7% of all hospitalized patients. The available information on the incidence and the characteristics of patients with ARF related to medicines is scarce. Aim To estimate the incidence of ARF related to medicines in hospitalized patients in non-critical areas and to compare their characteristics with those of patients with ARF due to other causes. Methods A prospective cohort of patients with ARF during hospital admission in non-critical areas was ascertained between July 2010 and July 2011. Information on patients’ demographics, medical antecedents, ARF risk factors, ARF severity according to the RIFLE classification and medicines was collected. The RIFLE classification detects patients with mildly impaired renal function with high sensitivity and to detect patients with significant renal dysfunction with high specificity. Analysis of the relationship of medicines with the ARF episodes was performed using the methods of the Spanish Pharmacovigilance System. A substudy of the direct economic cost of hospital-acquired IRA from the perspective of the hospital was performed. Results A total of 194 cases had an episode of hospital-acquired ARF in non-critical areas. The median age of patients was 72 years [IQR 59-79]; 60% were men. The ARF incidence during hospitalization was 9.6 per 1,000 admissions. According to the RIFLE classification a kidney injury was present in 48% of cases and kidney failure in 22%. In 105 (54.1%) cases, ARF was related to medicines; the most frequently involved were diuretics, agents acting on the renin-angiotensin system, immunosuppressants, β-blocking agents, calcium channel blockers, contrast media and non-steroids antiinflammatory drugs. Patients with ARF related to medicines had more morbidity, mainly cardiovascular, but less risk factors of ARF, less increased serum creatinine concentration during the episode and a lower mortality. Length of stay of patients with ARF during hospitalization tripled the average hospital (8.7 days), there was no difference in the length of hospital stay between the cases presented drug induced ARF and those with unrelated IRA medicines. The total average cost of the IRA was about 16.400 € ± 13,029 (median of € 12,150 [8492-20190]), without difference between the total cost among patients who presented ARF related to medicines and those with no drug-related ARF. Conclusions Half of ARF episodes during hospitalization in non-critical areas were related to medicines. Patients with ARF related to medicines had a higher cardiovascular morbidity than those with ARF related to other causes, but had a lower frequency of risk factors of ARF and mortality. The ARF related to medicines was less severe than the IRA unrelated to drugs.
Date of Award11 Nov 2015
Original languageSpanish
SupervisorM. Antonieta Agusti Escasany (Director) & Alfonso Segarra Medrano (Director)


  • Acute renal failure
  • Durg induced acute renal failure
  • Nephrotoxic medicinies

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