Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-ill children

Abstract

Background and objectives: Acute kidney injury (AKI) in hospitalized children results in increased patient morbidity and mortality. Nephrotoxic-medication exposure is a common cause of AKI. Currently, no data exist to quantify the risks of developing AKI for various nephrotoxic medications in children. The primary aim of the current study is to assess for a potential association between nephrotoxic medications and the risk of developing AKI in hospitalized noncritically ill children with no pre-existing renal insufficiency.

Design, setting, participants, & measurements: We performed a retrospective case-control study in pediatric hospitalized noncritically ill patients aged 1 day to 18 years. The cases were patients who developed AKI, as defined by the pediatric modified RIFLE (pRIFLE) criteria; patients without AKI served as controls and were matched by age category, gender, and disease state.

Results: 561/1660 (33.8%) patients identified for inclusion had AKI (441 category "R," 117 category "I," three category "F"); 357 cases were matched with 357 controls. Patients with AKI had longer length of hospital stay and increased hospital costs. Patients with AKI had exposure to more nephrotoxic medications for a longer period of time compared with controls. Odds of exposure for at least one nephrotoxic medication was significant for development of AKI. Exposure to more nephrotoxic medications was associated with an increased risk of AKI.

Conclusions: Increasing exposure to three or more nephrotoxic medications places pediatric patients at greater risk of acute kidney injury with resultant increased hospital costs and patient morbidity.

Figure 1.

Percentage of patients who developed AKI by total nephrotoxic-medication exposure. The x axis indicates the number of nephrotoxic-medication exposures, and the y axis indicates percentage of patients with AKI. n, study population with number of medication exposures.

Figure 2.

Percentage of patients who developed AKI by intensity of nephrotoxic-medication exposure. The x axis indicates the intensity of nephrotoxic-medication exposures, and the y axis indicates the percentage of patients with AKI. n, study population with number of medication exposures.