David M Axelrod1, Andrew T Anglemyer, Sara F Sherman-Levine, Aihua Zhu, Paul C Grimm, Stephen J Roth, Scott M Sutherland. 1. 1Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA. 2Institute for Global Health and Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA. 3Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Abstract
OBJECTIVE: To determine if aminophylline administration is associated with improved creatinine clearance and greater urine output in children with acute kidney injury in the cardiovascular ICU. DESIGN: Single-center retrospective cohort study. SETTING: Pediatric cardiovascular ICU, university-affiliated children's hospital. PATIENTS: Children with congenital or acquired heart disease in the cardiovascular ICU who received aminophylline to treat oliguric acute kidney injury and fluid overload. INTERVENTIONS: Patients received aminophylline after consultation with a pediatric nephrologist. Data were collected retrospectively over 7 days to assess if aminophylline was associated with improvement in creatinine clearance, urine output, and fluid overload. MEASUREMENTS AND MAIN RESULTS: Thirty-one patients received 52 aminophylline courses. Over the 7-day study period, serum creatinine decreased from a mean of 1.13 ± 0.91 to 0.87 ± 0.83 mg/dL (-0.05 mg/dL/d, p < 0.001). A concomitant increase was seen in estimated glomerular filtration rate from a mean of 50.0 ± 30.0 to 70.6 ± 58.1 mL/min/1.73 m (+3.66 mL/min/1.73 m/d, p < 0.001). Average daily urine output increased by 0.22 mL/kg/hr (p < 0.001), and fluid overload decreased on average by 0.42% per day in the 7-day study period (p = 0.005). Although mean furosemide dose increased slightly (0.12 mg/kg/d, p = 0.01), hydrochlorothiazide dosing did not significantly change over the study period. There were no complications related to aminophylline administration. CONCLUSIONS: Our study suggests that aminophylline therapy may be associated with significantly improved renal excretory function and may augment urine output in children who experience oliguric acute kidney injury in the cardiovascular ICU. Additionally, we did not identify any aminophylline-related side effects in this high-risk cardiac population. Future prospective studies are necessary to confirm the safety profile and to ensure that the beneficial effects are independent of other clinical interventions.
OBJECTIVE: To determine if aminophylline administration is associated with improved creatinine clearance and greater urine output in children with acute kidney injury in the cardiovascular ICU. DESIGN: Single-center retrospective cohort study. SETTING: Pediatric cardiovascular ICU, university-affiliated children's hospital. PATIENTS: Children with congenital or acquired heart disease in the cardiovascular ICU who received aminophylline to treat oliguric acute kidney injury and fluid overload. INTERVENTIONS:Patients received aminophylline after consultation with a pediatric nephrologist. Data were collected retrospectively over 7 days to assess if aminophylline was associated with improvement in creatinine clearance, urine output, and fluid overload. MEASUREMENTS AND MAIN RESULTS: Thirty-one patients received 52 aminophylline courses. Over the 7-day study period, serum creatinine decreased from a mean of 1.13 ± 0.91 to 0.87 ± 0.83 mg/dL (-0.05 mg/dL/d, p < 0.001). A concomitant increase was seen in estimated glomerular filtration rate from a mean of 50.0 ± 30.0 to 70.6 ± 58.1 mL/min/1.73 m (+3.66 mL/min/1.73 m/d, p < 0.001). Average daily urine output increased by 0.22 mL/kg/hr (p < 0.001), and fluid overload decreased on average by 0.42% per day in the 7-day study period (p = 0.005). Although mean furosemide dose increased slightly (0.12 mg/kg/d, p = 0.01), hydrochlorothiazide dosing did not significantly change over the study period. There were no complications related to aminophylline administration. CONCLUSIONS: Our study suggests that aminophylline therapy may be associated with significantly improved renal excretory function and may augment urine output in children who experience oliguric acute kidney injury in the cardiovascular ICU. Additionally, we did not identify any aminophylline-related side effects in this high-risk cardiac population. Future prospective studies are necessary to confirm the safety profile and to ensure that the beneficial effects are independent of other clinical interventions.
Authors: Ali Mirza Onder; David Rosen; Charles Mullett; Lesley Cottrell; Sherry Kanosky; Oulimata Kane Grossman; Hafiz Imran Iqbal; Eric Seachrist; Lennie Samsell; Kelly Gustafson; Larry Rhodes; Robert Gustafson Journal: Pediatr Crit Care Med Date: 2016-08 Impact factor: 3.624
Authors: Amanda M Uber; Maria E Montez-Rath; David M Kwiatkowski; Catherine D Krawczeski; Scott M Sutherland Journal: Pediatr Nephrol Date: 2018-07-09 Impact factor: 3.714
Authors: Paul Van Siang Lian Mang; Jun Chuen Hui; Rachel Si Jing Tan; M Shahnaz Hasan; Yao Mun Choo; Mohammed F Abosamak; Ka Ting Ng Journal: Eur J Pediatr Date: 2022-10-17 Impact factor: 3.860
Authors: David M Axelrod; Scott M Sutherland; Andrew Anglemyer; Paul C Grimm; Stephen J Roth Journal: Pediatr Crit Care Med Date: 2016-02 Impact factor: 3.624
Authors: Robert F Tamburro; Neal J Thomas; Gary D Ceneviva; Michael D Dettorre; Gretchen L Brummel; Steven E Lucking Journal: Front Pediatr Date: 2014-06-12 Impact factor: 3.418