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Clinical Characteristics and Outcomes of Drug-Induced Acute Kidney Injury Cases

Yousif, Zaid K., Koola, Jejo D., Macedo, Etienne, Cerda, Jorge, Goldstein, Stuart L., Chakravarthi, Rajasekara, Lewington, Andrew, Selewski, David, Zappitelli, Michael, Cruz, Dinna, and others. (2023) Clinical Characteristics and Outcomes of Drug-Induced Acute Kidney Injury Cases. Kidney International Reports, 8 (11). pp. 2333-2344. ISSN 2468-0249. (doi:10.1016/j.ekir.2023.07.037) (KAR id:102479)



Drug-induced acute kidney injury (DI-AKI) is a frequent adverse event. The identification of DI-AKI is challenged by competing etiologies, clinical heterogeneity among patients, and a lack of accurate diagnostic tools. Our research aims to describe the clinical characteristics and predictive variables of DI-AKI.


We analyzed data from the DIRECT study (NCT02159209), an international, multi-center, observational cohort study of enriched clinically adjudicated DI-AKI cases. Cases met the primary inclusion criteria if the patient was exposed to at least one nephrotoxic drug for a minimum of 24 hours prior to acute kidney injury (AKI) onset. Cases were clinically adjudicated and inter-rater reliability (IRR) was measured using Krippendorff's alpha. Variables associated with DI-AKI were identified using L1 regularized multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (ROC AUC).


314 AKI cases met the eligibility criteria for this analysis, and 271 (86%) cases were adjudicated as DI-AKI. The majority of the AKI cases were recruited from the United States (68%). The most frequent causal nephrotoxic drugs were vancomycin (48.7%), non-steroidal anti-inflammatory drugs (18.2%), and piperacillin/tazobactam (17.8%). The IRR for DI-AKI adjudication was 0.309. The multivariable model identified age, vascular capacity, hyperglycemia, infections, pyuria, serum creatinine trends, and contrast media as significant predictors of DI-AKI with good performance, ROC AUC 0.86.


The identification of DI-AKI is challenging even with comprehensive adjudication by experienced nephrologists. Our analysis identified key clinical characteristics and outcomes of DI-AKI compared to other AKI etiologies.

Item Type: Article
DOI/Identification number: 10.1016/j.ekir.2023.07.037
Uncontrolled keywords: drug induced acute kidney injury; phenotype; nephrotoxicity; causality assessment
Subjects: R Medicine
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 18 Aug 2023 13:28 UTC
Last Modified: 15 Apr 2024 13:19 UTC
Resource URI: (The current URI for this page, for reference purposes)

University of Kent Author Information

Farmer, Christopher K..

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