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Multicenter Study
. 2023 Dec;45(1):2218486.
doi: 10.1080/0886022X.2023.2218486.

Risk of chronic kidney disease in children who developed acute kidney injury secondary to nephrotoxic medication exposure in infancy

Affiliations
Multicenter Study

Risk of chronic kidney disease in children who developed acute kidney injury secondary to nephrotoxic medication exposure in infancy

Priyanka Ameta et al. Ren Fail. 2023 Dec.

Abstract

Introduction: Nephrotoxic medication (NTM) is one of the common causes of acute kidney injury (AKI) in critically ill infants. Current knowledge about the long-term effects of NTM exposure and associated AKI during the neonatal period and early infancy is limited. Hence, we aimed to explore the risk of chronic kidney disease (CKD) after NTM-AKI in this age group.

Methods: We performed a cross-sectional study including children 2-7 years of age, who had a history of high NTM exposure during NICU hospitalization. Cases and controls were defined as children who developed AKI and who did not develop AKI after NTM exposure, respectively. The primary outcome of interest was to explore the prevalence of composite CKD. In addition, we explored differences in urinary biomarker kidney injury molecule-1 (KIM-1) between the groups.

Results: We enrolled 48 children, 18 cases and 30 controls in which 25/48 (52%) had at least one finding of CKD. The composite CKD outcome tended to be higher in cases vs controls (61.1% vs. 46.6%, odds ratio = 1.79 (95% confidence interval 0.54-5.8)); however, this was not statistically significant. Median urinary KIM-1 value trended higher in controls, 0.367(0.23-0.59) vs. 0.20 (IQR 0.11-0.47), which was not statistically significant.

Conclusion: In this study, 52% of children exposed to NTM had at least one marker of CKD at a median age of 5 years. Multicenter, large prospective studies are needed to improve our understanding of the natural course of NTM-AKI and to determine risk factors and strategies to reduce CKD in this high-risk population.

Keywords: Nephrotoxic medication; acute kidney injury; chronic kidney disease.

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Conflict of interest statement

This statement is to certify that all Authors have seen and approved the manuscript being submitted. We warrant that the article is the Authors’ original work. We warrant that the article has not received prior publication and is not under consideration for publication elsewhere. On behalf of all Coauthors, the corresponding Author shall bear full responsibility for the submission. This research has not been submitted for publication nor has it been published in whole or in part elsewhere. We attest to the fact that all Authors listed on the title page have contributed significantly to the work, have read the manuscript, and attest to the validity and legitimacy of the data and its interpretation. The work for this study was performed at the University of Alabama at Birmingham.

Figures

Figure 1.
Figure 1.
shows the flow chart of the study population recruitment. Of 466 eligible participants, 18 cases and 30 controls were enrolled for the study.

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