Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: a retrospective cohort study

Zappitelli, Michael; Moffett, Brady S.; Hyder, Ayaz; Goldstein, Stuart L.

doi:10.1093/ndt/gfq375

Cited by 142 publications

(109 citation statements)

References 41 publications

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“…Depending on the definition used, AKI occurred in 37%-51% of at-risk hospitalizations; at-risk was defined as having a baseline and at least one additional creatinine obtained. This is consistent with previously published reports using newer, standard definitions based on creatinine change (8,13,18,19). Our study also suggests that much pediatric AKI is of mild severity as 45%-53% of cases were classified as stage 1.…”

Section: Discussionsupporting

confidence: 93%

AKI in Hospitalized Children

Sutherland

Byrnes

Kothari

et al. 2015

Clinical Journal of the American Society of Nephrology

386

254

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Background and objectives Although several standardized definitions for AKI have been developed, no consensus exists regarding which to use in children. This study applied the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria to an anonymized cohort of hospitalizations extracted from the electronic medical record to compare AKI incidence and outcomes in intensive care unit (ICU) and non-ICU pediatric populations.Design, setting, participants, & measurements Observational, electronic medical record-enabled study of 14,795 hospitalizations at the Lucile Packard Children's Hospital between 2006 and 2010. AKI and AKI severity stage were defined by the pRIFLE, AKIN, and KDIGO definitions according to creatinine change criteria; urine output criteria were not used. The incidences of AKI and each AKI stage were calculated for each classification system. All-cause, in-hospital mortality and total hospital length of stay (LOS) were compared at each subsequent AKI stage by Fisher exact and Kolmogorov-Smirnov tests, respectively.Results AKI incidences across the cohort according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. Mortality was higher among patients with AKI across all definitions (pRIFLE, 2.3%; AKIN, 2.7%; KDIGO, 2.5%; P,0.001 versus no AKI [0.8%-1.0%]). Within the ICU, pRIFLE, AKIN, and KDIGO demonstrated progressively higher mortality at each AKI severity stage; AKI was not associated with mortality outside the ICU by any definition. Both in and outside the ICU, AKI was associated with significantly higher LOS at each AKI severity stage across all three definitions (P,0.001). Definitions resulted in differences in diagnosis and staging of AKI; staging agreement ranged from 76.7% to 92.5%.Conclusions Application of the three definitions led to differences in AKI incidence and staging. AKI was associated with greater mortality and LOS in the ICU and greater LOS outside the ICU. All three definitions demonstrated excellent interstage discrimination. While each definition offers advantages, these results underscore the need to adopt a single, universal AKI definition.

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Section: Discussionsupporting

confidence: 93%

AKI in Hospitalized Children

Sutherland

Byrnes

Kothari

et al. 2015

Clinical Journal of the American Society of Nephrology

386

254

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“…[10][11][12] Recent studies have found AKI among noncritically ill patients to be associated with exposure to multiple nephrotoxins and to aminoglycoside antibiotics specifi cally. 11,12 Accurate detection of AKI relies on serial measurements of serum creatinine (SCr) level or urine output over time. 13 However, noncritically ill pediatric patients are often not monitored for AKI and providers may miss an opportunity to prevent or diagnose AKI.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

“…13 However, noncritically ill pediatric patients are often not monitored for AKI and providers may miss an opportunity to prevent or diagnose AKI. 11,12 The epidemiology of nephrotoxin-associated AKI on a large scale is therefore not well understood.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

“…Adequate SCr screening was defi ned as 2 measurements obtained ≤96 hours apart during an admission. This time period was chosen because we knew that daily screening was unlikely 11,12 and estimated that at least half of nephrotoxin-exposed patients would be screened every 96 hours (unpublished data). For the comparison cohort, exposure defi nitions were identical except for intravenous contrast material, for which exposure counted toward the day of and 6 days after the infusion, and adequate screening, which was defi ned as SCr measurement every day of exposure.…”

Section: Exposure Defi Nitionsmentioning

confidence: 99%

“…12,13,26,27 Because nephrotoxin-associated AKI is usually nonoliguric in nature 28 and urine output data were unavailable, we did not use the pRIFLE urine output criteria. The pRIFLE-R stratus is considered injury by its 25% decrease in estimated creatinine clearance and was therefore included in this study.…”

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confidence: 99%

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Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

Schaffzin¹,

Dodd

Nguyen

et al. 2014

Hospital Pediatrics

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Objectives: Nephrotoxin exposure is a common cause of acute kidney injury (AKI) in hospitalized children. AKI detection relies on regular serum creatinine (SCr) screening among exposed patients. We sought to determine how well administrative data identify hospitalized noncritically ill children with nephrotoxic medication-associated AKI in the contexts of incomplete and complete screening. Methods: We conducted a single-center retrospective cohort study among noncritically ill hospitalized children. We compared administrative data sensitivity to that among a separate cohort for whom adequate screening was defined as daily SCr measurement. For the original cohort, nephrotoxin exposure was defined as exposure to ≥3 nephrotoxins at once or ≥3 days of aminoglycoside therapy. AKI was defined by the change in SCr (pediatric-modified Risk Injury Failure Loss End-Stage Renal Disease [pRIFLE] criteria) or discharge code. Adequate SCr screening was defined as 2 measurements obtained ≤96 hours apart. Administrative data and laboratory values were merged to compare AKI by discharge code and pRIFLE criteria. Results: 747 of 1472 (50.7%) nephrotoxin-exposed patients were adequately screened; 82 (11.0%) had AKI by pRIFLE criteria, 52 (7.0%) by discharge code. Sensitivity of nephrotoxin-associated AKI diagnosis by discharge code compared with pRIFLE criteria was 23.2% (95% confidence interval = 14.0–32.3). In the comparison cohort, 70 (26.8%) patients had AKI by pRIFLE criteria and 26 (10.0%) by discharge code; sensitivity was 21.4% (95% confidence interval = 11.8%–31.0%). Conclusions: pRIFLE criteria identified more patients than were identified by discharge code. Identifying patients with nephrotoxin-associated AKI by discharge code, even in the presence of complete AKI detection, underrepresents the true incidence of nephrotoxin-associated AKI in hospitalized children.

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Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

et al. 2022

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ImportanceIncreasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge.ObjectiveTo develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy.Evidence ReviewAt the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations.FindingsThe meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy.Conclusions and RelevanceExisting evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.

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Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: a retrospective cohort study

Abstract: 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.

Cited by 142 publications

References 41 publications

AKI in Hospitalized Children

AKI in Hospitalized Children

Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children

Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children

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