BACKGROUND: Aminoglycosides (AG) cause acute kidney injury (AKI), but the incidence and severity distribution are unclear, particularly in non-critically ill children. We determined the incidence, severity and risk factors of AG-associated AKI and assessed for associations with longer hospitalization and higher costs. METHODS: At Texas Children's Hospital, we conducted a retrospective cohort study of children treated with AG for ≥ 5 days in 2005, excluding children with admission primary renal diagnoses. AKI was defined by the paediatric Risk, Injury, Failure, Loss, End Stage Kidney Disease (pRIFLE) and Acute Kidney Injury Network (AKIN) definitions. Multiple logistic and linear regression analyses were used to assess independence of associations with outcomes. RESULTS: Five hundred and fifty-seven children [mean ± SD age = 8.0 ± 5.9 years, 286 (51%) male, 489 (88%) gentamicin] were studied. The AKI rate was 33% and 20% by pRIFLE and AKIN definitions, respectively. Longer treatment, higher baseline estimated glomerular filtration rate, being on a medicine (versus surgical) treatment service and prior AG treatment were independent risk factors for AKI development. AKI by pRIFLE or AKIN was independently associated with longer hospital stay and higher total hospital costs. The pRIFLE definition was more sensitive for AKI detection, but the AKIN definition was more strongly related to outcomes. CONCLUSIONS: AKI is common and associated with poorer outcomes in non-critically ill children treated with AG. Future research should attempt to understand how to best define AKI in the non-critical illness paediatric setting.
BACKGROUND:Aminoglycosides (AG) cause acute kidney injury (AKI), but the incidence and severity distribution are unclear, particularly in non-critically ill children. We determined the incidence, severity and risk factors of AG-associated AKI and assessed for associations with longer hospitalization and higher costs. METHODS: At Texas Children's Hospital, we conducted a retrospective cohort study of children treated with AG for ≥ 5 days in 2005, excluding children with admission primary renal diagnoses. AKI was defined by the paediatric Risk, Injury, Failure, Loss, End Stage Kidney Disease (pRIFLE) and Acute Kidney Injury Network (AKIN) definitions. Multiple logistic and linear regression analyses were used to assess independence of associations with outcomes. RESULTS: Five hundred and fifty-seven children [mean ± SD age = 8.0 ± 5.9 years, 286 (51%) male, 489 (88%) gentamicin] were studied. The AKI rate was 33% and 20% by pRIFLE and AKIN definitions, respectively. Longer treatment, higher baseline estimated glomerular filtration rate, being on a medicine (versus surgical) treatment service and prior AG treatment were independent risk factors for AKI development. AKI by pRIFLE or AKIN was independently associated with longer hospital stay and higher total hospital costs. The pRIFLE definition was more sensitive for AKI detection, but the AKIN definition was more strongly related to outcomes. CONCLUSIONS: AKI is common and associated with poorer outcomes in non-critically ill children treated with AG. Future research should attempt to understand how to best define AKI in the non-critical illness paediatric setting.
Authors: Tracy L McGregor; Deborah P Jones; Li Wang; Ioana Danciu; Brian C Bridges; Geoffrey M Fleming; Jana Shirey-Rice; Lixin Chen; Daniel W Byrne; Sara L Van Driest Journal: Am J Kidney Dis Date: 2015-08-28 Impact factor: 8.860
Authors: Scott M Sutherland; John J Byrnes; Manish Kothari; Christopher A Longhurst; Sanjeev Dutta; Pablo Garcia; Stuart L Goldstein Journal: Clin J Am Soc Nephrol Date: 2015-02-03 Impact factor: 8.237
Authors: E S Kirkendall; W L Spires; T A Mottes; J K Schaffzin; C Barclay; S L Goldstein Journal: Appl Clin Inform Date: 2014-04-02 Impact factor: 2.342
Authors: Kevin J Downes; Neha R Patil; Marepalli B Rao; Rajesh Koralkar; William T Harris; John P Clancy; Stuart L Goldstein; David J Askenazi Journal: Pediatr Nephrol Date: 2015-04-26 Impact factor: 3.714