Risk of Kidney Disease Doubled With Use of Fluoroquinolone Antibiotics

[Karol]

Risk of Kidney Disease Doubled With Use of Fluoroquinolone Antibiotics
June 3, 2013 — The risk of acute kidney disease is doubled for people taking oral fluoroquinolone antibiotics, according to a study of published in CMAJ (Canadian Medical Association Journal).

Fluoroquinolones, including ciprofloxacin, levofloxacin and moxifloxacin, are common broad-spectrum antibiotics most often used to treat respiratory and urogenital infections. Case reports have indicated acute kidney injury with use, and prescription labels carry a warning of kidney failure. However, when oral fluoroquinolones are prescribed in clinical practice, kidney injury is usually not considered.
Researchers from the US and Canada undertook a study to determine the risk of acute kidney injury with the use of oral fluoroquinolones for adult men 40󈟁 years old enrolled in the US LifeLink Health Plan Claims Database between 2001 and 2011. There were 1292 cases of acute kidney disease and 12 651 controls in the study. Researchers excluded people who had a history of chronic kidney disease or dialysis because they can increase the risk of acute injury. They found that current use of oral fluoroquinolones increased the risk of acute kidney injury; the risk was highest with ciprofloxacin, followed by moxifloxacin. Past use did not increase the risk nor did the use of amoxicillin or azithromycin. They also found that concurrent use of an oral fluoroquinolone and a renin-angiotensin-system blocker, a popular class of cardiovascular medication, increases the risk of acute renal failure by 4.5 fold.
"We found a twofold increased risk of acute kidney injury requiring hospital admission with the use of fluoroquinolone antibiotics among adult men, using 2 analytic techniques," writes Dr. Mahyar Etminan, of the Child & Family Research Institute, Department of Pediatrics, University of British Columbia, and the Provincial Health Services Authority, with coauthors.
"The twofold differential in risk in current users suggests that acute kidney injury secondary to fluoroquinolone use is an acute adverse event."
The authors suggest that physicians need to be aware of the risks of kidney injury when prescribing these drugs. "Although it is clear that the risk of death due to serious infections outweighs the risks associated with the use of fluoroquinolones, the potential for acute kidney injury raises the importance of vigilant prescribing," they conclude.

http://www.sciencedaily.com/releases/2013/06/130603135311.htm

[Clark]

My recent medication resistant infection was most successfully finally eradicated by cipro- and levofloxicin. My status as a donor and my advanced directive to receive no nephrotoxic medication were both explicitly considered by the team treating me. While nephrotoxicity is listed as a potential side effect of these meds, I was reassured, and persuaded, that the 10% rate in this study, and the lower percent in the trials that led up to approval of these meds, is almost certainly and completely the result of the infections being treated, not the meds. Their chemical action is not toxic to nephrons or their vascular support, so the mechanism by which they might be implicated as nephrotoxic is otherwise not explained.

If you are prescribed one of these meds, get the full explanation of why, and get your provider's take on the risk to your remaining kidney. As I've said elsewhere, I was treated rapidly, in depth, and effectively, not least because the professionals were aware of the stakes for me and my lone right kidney. Best wishes, all.