Kevin J Downes1, Marepalli B Rao2, Laurie Kahill3, Hovi Nguyen4, John P Clancy3, Stuart L Goldstein4. 1. Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: kevin.downes@cchmc.org. 2. Biostatistics and Epidemiology, University of Cincinnati, Cincinnati, OH, USA. 3. Division of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 4. The Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Abstract
BACKGROUND: The epidemiology of aminoglycoside-associated acute kidney injury (AG-AKI) has not been well described in pediatric patients with cystic fibrosis (CF). We aimed to assess the impact of daily serum creatinine (SCr) measurement on detection of AG-AKI at our institution. METHODS: We examined a cohort of hospitalized patients with CF who received an intravenous (IV) aminoglycoside for ≥ 3 days. We compared the rate, timing, and medical management surrounding detection of AG-AKI during 2 periods: January 2010-May 2011 (Era 1, SCr measured at the discretion of the medical team, N=124) and June 2011-June 2012 (Era 2, SCr measured daily, N=103). Our primary outcome was detection of AG-AKI defined as ≥ 50% increase in SCr from baseline (lowest value in prior 6 months), or ≥ 0.3mg/dL rise within 48 h, occurring after day 2. RESULTS: The use of once daily tobramycin (p=0.02) and IV fluids (p<0.001) was higher during Era 2, while AG courses were shorter (p=0.04), and fewer concomitant nephrotoxins (p=0.04) were given; higher daily tobramycin doses (p<0.001) were administered. Although the rate of AG-AKI was not significantly different (12% during Era 1 vs. 20% during Era 2, p=0.09), the number of AG-AKI days detected increased (5.5 vs. 2.9 per 100 AG days, p=0.003), and detection occurred earlier (median 6 vs. 9 days, log rank test p=0.02) during the daily SCr period. CONCLUSIONS: Daily SCr measurement promoted earlier and increased detection of AG-AKI in patients with CF at our institution. We suggest systematic evaluation for AKI during aminoglycoside administration in patients with CF.
BACKGROUND: The epidemiology of aminoglycoside-associated acute kidney injury (AG-AKI) has not been well described in pediatric patients with cystic fibrosis (CF). We aimed to assess the impact of daily serum creatinine (SCr) measurement on detection of AG-AKI at our institution. METHODS: We examined a cohort of hospitalized patients with CF who received an intravenous (IV) aminoglycoside for ≥ 3 days. We compared the rate, timing, and medical management surrounding detection of AG-AKI during 2 periods: January 2010-May 2011 (Era 1, SCr measured at the discretion of the medical team, N=124) and June 2011-June 2012 (Era 2, SCr measured daily, N=103). Our primary outcome was detection of AG-AKI defined as ≥ 50% increase in SCr from baseline (lowest value in prior 6 months), or ≥ 0.3mg/dL rise within 48 h, occurring after day 2. RESULTS: The use of once daily tobramycin (p=0.02) and IV fluids (p<0.001) was higher during Era 2, while AG courses were shorter (p=0.04), and fewer concomitant nephrotoxins (p=0.04) were given; higher daily tobramycin doses (p<0.001) were administered. Although the rate of AG-AKI was not significantly different (12% during Era 1 vs. 20% during Era 2, p=0.09), the number of AG-AKI days detected increased (5.5 vs. 2.9 per 100 AG days, p=0.003), and detection occurred earlier (median 6 vs. 9 days, log rank test p=0.02) during the daily SCr period. CONCLUSIONS: Daily SCr measurement promoted earlier and increased detection of AG-AKI in patients with CF at our institution. We suggest systematic evaluation for AKI during aminoglycoside administration in patients with CF.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Glenn M Chertow; Elisabeth Burdick; Melissa Honour; Joseph V Bonventre; David W Bates Journal: J Am Soc Nephrol Date: 2005-09-21 Impact factor: 10.121
Authors: Marius C Florescu; Elizabeth Lyden; Peter J Murphy; Diana F Florescu; Jennifer Fillaus Journal: Hemodial Int Date: 2012-04-03 Impact factor: 1.812
Authors: Jack F Price; Antonio R Mott; Heather A Dickerson; John Lynn Jefferies; David P Nelson; Anthony C Chang; E O'Brian Smith; Jeffrey A Towbin; William J Dreyer; Susan W Denfield; Stuart L Goldstein Journal: Pediatr Crit Care Med Date: 2008-05 Impact factor: 3.624
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: Kevin J Downes; Austyn Grim; Laura Shanley; Ronald C Rubenstein; Athena F Zuppa; Marc R Gastonguay Journal: Antimicrob Agents Chemother Date: 2022-04-28 Impact factor: 5.191
Authors: Li Wang; Tracy L McGregor; Deborah P Jones; Brian C Bridges; Geoffrey M Fleming; Jana Shirey-Rice; Michael F McLemore; Lixin Chen; Asli Weitkamp; Daniel W Byrne; Sara L Van Driest Journal: Pediatr Res Date: 2017-05-31 Impact factor: 3.756
Authors: Stephen J McWilliam; Daniel J Antoine; Andrea L Jorgensen; Rosalind L Smyth; Munir Pirmohamed Journal: Sci Rep Date: 2018-03-23 Impact factor: 4.379
Authors: Sara L Van Driest; Li Wang; Michael F McLemore; Brian C Bridges; Geoffrey M Fleming; Tracy L McGregor; Deborah P Jones; Jana Shirey-Rice; Cheryl L Gatto; James C Gay; Daniel W Byrne; Asli Weitkamp; Dan M Roden; Gordon Bernard Journal: Pediatr Res Date: 2019-08-27 Impact factor: 3.756