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Int. J. Environ. Res. Public Health 2015, 12(9), 11227-11240; doi:10.3390/ijerph120911227

Drug-Induced Nephrotoxicity and Dose Adjustment Recommendations: Agreement Among Four Drug Information Sources

Maternidade Hospital Octaviano Neves, Rua Ceará, 186, Bairro Santa Efigênia, Belo Horizonte CEP 30150-310, MG, Brazil
Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, CEP 31270-901, MG, Brazil
Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, CEP 30130-100, MG, Brazil
Hospital Risoleta Tolentino Neves, R. das Gabirobas, Bairro Vila Cloris, Belo Horizonte, 31744-012, MG, Brazil
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 27 June 2015 / Revised: 17 August 2015 / Accepted: 31 August 2015 / Published: 9 September 2015
View Full-Text   |   Download PDF [677 KB, uploaded 9 September 2015]   |  


: Hospitalized patients require the use of a variety of drugs, many of which individually or in combination have the potential to cause kidney damage. The use of potentially nephrotoxic drugs is often unavoidable, and the need for dose adjustment should be evaluated. This study is aimed at assessing concordance in information on drug-induced nephrotoxicity and dose adjustment recommendations by comparing four drug information sources (DRUGDEX®, UpToDate®, Medscape® and the Brazilian Therapeutic Formulary) using the formulary of a Brazilian public hospital. A total of 218 drugs were investigated. The global Fleiss’ kappa coefficient was 0.265 for nephrotoxicity (p < 0.001; CI 95%, 0.211–0.319) and 0.346 for recommendations (p < 0.001; CI 95%, 0.292–0.401), indicating fair concordance among the sources. Anti-infectives and anti-hypertensives were the main drugs cited as nephrotoxic by the different sources. There were no clear definitions for qualitative data or quantitative values for dose adjustments among the four information sources. There was no advice for dosing for a large number of the drugs in the international databases. The National Therapeutic Formulary offered imprecise dose adjustment recommendations for many nephrotoxic drugs. Discrepancies among information sources may have a clinical impact on patient care and contribute to drug-related morbidity and mortality. View Full-Text
Keywords: kidney insufficiency; drug toxicity; drug information kidney insufficiency; drug toxicity; drug information

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Bicalho, M.D.; Soares, D.B.; Botoni, F.A.; Reis, A.M.M.; Martins, M.A.P. Drug-Induced Nephrotoxicity and Dose Adjustment Recommendations: Agreement Among Four Drug Information Sources. Int. J. Environ. Res. Public Health 2015, 12, 11227-11240.

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