Fármacos nefrotóxicos utilizados por idosos: uma revisão integrativa da literatura.

Abstract

As a result of the physiological process of aging, the elderly are more affected by drug interactions, toxicity events and adverse drug effects. Associated comorbidities favor the occurrence of polypharmacy, considered a risk factor for nephrotoxicity. Therefore, the general objective of this work was to describe the main nephrotoxic drugs used by the elderly and their effects that induce acute kidney injury. This is an integrative review of the literature that aims to gather and synthesize knowledge on a defined topic, assisting in decision-making and improvements in clinical practice. The search for studies consistent with the theme took place in electronic databases: Virtual Health Library (VHL), Portal Periódicos Capes, ScienceDirect and Pubmed/Medline, between the years 2013 and 2023. Search strategies were used that resulted in the identification of 293 studies and after evaluation according to the inclusion and exclusion criteria, 10 studies were selected. This work showed that the main nephrotoxic drugs used by the elderly were: antibiotics from the classes of aminoglycosides (gentamicin), glycopeptides (vancomycin) and sulfonamides (sulfamethoxazole-trimethoprim), antihypertensives (angiotensin-converting enzyme inhibitors and receptor blockers angiotensin II), the loop diuretic furosemide, the antifungal amphotericin B, non-steroidal anti-inflammatory drugs, antineoplastics (cisplatin and methotrexate) and radiological contrast media. The main effects inducing acute kidney injury consisted of hemodynamic changes (systemic and glomerular), decreased pressure, low glomerular filtration, ischemic events, oxidative damage, cell apoptosis, tissue necrosis and physical tubular lesions caused by crystals. Therefore, the pharmaceutical professional inserted in the community and in the hospital, by offering clinical services such as pharmacotherapeutic monitoring, medication reconciliation, therapeutic monitoring and medication dispensing, plays an important role in preventing the occurrence of acute kidney injury in elderly people due to the use of nephrotoxic drugs, promoting a reduction in the occurrence of adverse reactions and dangerous drug interactions for this population.