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

Area of Science:

• Pharmacology
• Nephrology
• Clinical Pharmacy

Background:

• Nephrotoxin exposure is a significant risk factor for acute kidney injury (AKI).
• A standardized list and perceived nephrotoxic potential (NxP) of medications for non-critically ill patients are currently lacking.
• This gap hinders effective surveillance and management of drug-induced kidney damage in general hospital settings.

Purpose of the Study:

• To generate expert consensus on the nephrotoxic potential (NxP) of 195 commonly used medications in non-intensive care settings.
• To establish a standardized rating scale for perceived nephrotoxicity.
• To provide a foundation for improved clinical monitoring and research into nephrotoxic medications.

Main Methods:

• A comprehensive literature search identified potentially nephrotoxic medications.
• 29 experts in nephrology and pharmacy rated the NxP of 195 medications on a 0-3 scale.
• Consensus was defined as ≥75% of participants providing a single rating or two consecutive ratings.

Main Results:

• Consensus was achieved for 152 medications, with 39 removed from consideration.
• The majority of rated medications were classified as unlikely to possibly nephrotoxic (rating 0.5) or possibly to probably nephrotoxic (rating 1.5).
• No medications were rated as definitely nephrotoxic (rating 3) by consensus.

Conclusions:

• The NxP index provides valuable clinical consensus on the perceived nephrotoxicity of medications in non-critical care.
• This standardized rating facilitates consistent clinical evaluations and future research endeavors.
• The findings support the development of targeted strategies to mitigate nephrotoxic medication risks in non-critically ill patients.