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. 2017;4(4):1070.
Epub 2017 Jul 22.

Nephrotoxic Medications and Associated Acute Kidney Injury in Very Low Birth Weight Infants

M Barhight  1 , M Altaye  2 , K M Gist  3 , B Isemann  4 , S L Goldstein  5 , H Akinbi  6
Affiliations

Nephrotoxic Medications and Associated Acute Kidney Injury in Very Low Birth Weight Infants

M Barhight et al. J Clin Nephrol Res. 2017.

Abstract

Preterm infants are at risk for acute kidney injury (AKI) for multiple reasons. Reports on the frequency and timeline of iatrogenic renal insults and potential consequences are limited. Our objectives are to estimate the prevalence and timing of exposure to nephrotoxic medications, and assess the association of these nephrotoxic medications with AKI in preterm infants. We performed a retrospective chart review of infants <30 weeks postmenstrual age and/or <1500 g birth weight admitted to the neonatal intensive care units at Cincinnati Children's Hospital Medical Center and University of Cincinnati Medical Center from 2011 to 2014. We queried the electronic health record for exposures to nephrotoxic medications and/or radiologic contrast media and correlated to serum creatinine concentration proximate to the exposure. Using the Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria, we assessed the AKI rate associated with the exposures. The cohort included 276 preterm infants. 233 (84%) received nephrotoxicity-associated medications. Antibiotics were the most common type (80%). AKI occurred in 9% of infants and was associated with exposure to a nephrotoxic medication. In a forward stepwise logistical regression, birth weight (OR: 0.995 (95% CI: 0.991-0.998), p=0.004) and number of exposures (OR: 1.83 (95% CI: 1.33-2.53), p=0.0002) were predictive of AKI. Nephrotoxic medication exposure increased the odds of AKI in preterm and low birth weight infants. Future prospective surveillance through the electronic health record in addition to routine serum creatinine monitoring may reduce the rate of exposure and subsequent AKI.

Keywords: Acute kidney injury; Amino glycosides; Nephrotoxic; Premature infants; Very low birth weight infants.

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Conflict of interest statement

Conflict of Interest: The authors have no other financial or ethical conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study cohort.
Figure 2
Figure 2
Exposure Types.
Figure 3
Figure 3
Timeline of Nephrotoxic Exposures and Acute Kidney Injury during NICU Course by weeks of age.
See this image and copyright information in PMC

References

    1. Carmody JB, Charlton JR. Short-term gestation, long-term risk: prematurity and chronic kidney disease. Pediatrics. 2013;131:1168–1179. - PubMed
    1. Askenazi DJ, Griffin R, McGwin G, Carlo W, Ambalavanan N. Acute kidney injury is independently associated with mortality in very low birthweight infants: a matched case-control analysis. Pediatr Nephrol. 2009;24:991–997. - PubMed
    1. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69:184–189. - PubMed
    1. Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res. 2011;69:354–358. - PubMed
    1. Rodriguez MM, Gomez A, Abitbol C, Chandar J, Montané B, Zilleruelo G. Comparative renal histomorphometry: a case study of oligonephropathy of prematurity. Pediatr Nephrol. 2005;20:945–949. - PubMed

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