Drug-Associated Renal Dysfunction Stephanie S. Taber, PharmD T , Bruce A. Mueller, PharmD Department of Clinical Sciences, University of Michigan College of Pharmacy, 1500 East Medical Center Drive, UHB2D301 Box 0008, Ann Arbor, MI 48109, USA The development of acute renal failure (ARF) that requires renal replacement therapy is one of the most catastrophic events that can occur in a critically ill patient. ARF occurs in approximately 6% of patients in the ICU [1]. The mor- tality of patients in the ICU who require any type of renal replacement is greater than 50% [1]; this rate has not changed since the advent of dialysis [2]. Pre- existing renal disease and left ventricular dysfunction have been identified as risk factors for the development of ARF [3]. Although clinicians recognize the seriousness of ARF in the ICU, little has been done to assess the overall con- tribution that pharmacotherapy has on the development of ARF. Sepsis gen- erally is regarded as the most common cause of ARF in the ICU [4], but clinicians recognize that drug therapies are important contributors to renal dys- function in the ICU. One small case series estimated that up to 14% of all cases of ARF in the ICU were caused by drugs [4]. It is difficult to determine the overall contribution of drug-induced renal dysfunction in the ICU because of the complexity of critically ill patients. Many of the essential drugs in the ICU (eg, antibiotics, vasopressors, intravenous contrast dye) are widely known to be nephrotoxic, yet they continue to be used because less toxic agents are unavailable or are less effective. To determine how often potentially nephrotoxic drugs are used in the ICUs in the authors’ own institution, a brief drug use evaluation was conducted. 0749-0704/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.ccc.2006.02.003 criticalcare.theclinics.com T Corresponding author. E-mail address: staber@umich.edu (S.S. Taber). Crit Care Clin 22 (2006) 357 – 374