(29) Antibiotic-associated acute kidney injury among older adults: A case-crossover study

ABSTRACT: Abstract

Purpose: Drug-related acute kidney injury (AKI) is more common among older adults 65 years or above than the general population, and the associated drugs, including antibiotics, are often co-prescribed. However, most antibiotic-related research focuses on the drugs’ benefits with much lesser attention to the associated adverse drug events. Using a case-crossover study design, we ascertained antibiotic-associated acute kidney injury (AKI) in older adults.

Methods: We used the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification code N17.9 to identify all individuals aged 65 years and above with a diagnosis of incident AKI between January 01, 2005, and December 31, 2020, from the New Zealand National Minimum Data Set. From the data, a case-crossover cohort for antibiotic exposures was created, with a 3-day observation period and two 30 days washout periods, summed up to a 66-day study period. We then calculated the changed odds of acute kidney injury due to exposures to an antibiotic as matched odds ratios and their 95% confidence intervals, using conditional logistic regression and adjusting for the effect of co‐medication

Results: We identified a total of 2399 incident cases of AKI between 2005 and 2020 among older adults. The adjusted odds of consuming a sulphonamide antibiotic during the case period was 3.57 times (95% confidence interval: 2.86 to 4.46) higher than the reference period among the incident AKI cases. Fluoroquinolone utilisation was also considerably associated with incident AKI (adjusted matched odds ratio = 2.56; 95% confidence interval: 1.90 to 3.46). On the other hand, consumption of a tetracycline antibiotic during the case period was not associated with AKI (matched OR = 1.20; 95% CI: 0.80 – 1.78).

Conclusion: The potential of sulphonamides and fluoroquinolones to cause AKI among older adults raises the significant need for vigilant prescribing of these antibiotics. Consideration must be given to an appropriate choice of antibiotic in severely ill patients who may be at risk of AKI.