Xanthine Derivatives for Kidney Protection in the Critically Ill Pediatric Population: A Systematic Review

Flores, Saúl; Culichia, Corissa N.; Villarreal, Enrique G.; Savorgnan, Fabio; Checchia, Paul A.; Loomba, Rohit S.

doi:10.1055/s-0040-1705178

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…Urine output increased by 3.36 mL/kg/h in the pooled analyses. 8 While the magnitude of change was not the same between the pooled analysis and the current study findings, the direction of change is the same. Creatinine also had the same direction of change in both studies, and in both studies, it trended toward significance but did not quite reach statistical significance.…”

Section: Discussioncontrasting

confidence: 50%

The Effect of Aminophylline on Urine Output and Fluid Balance after a Single Dose in Children Admitted to the Pediatric Cardiac Intensive Care Unit

Loomba

Uppuluri

Chandra

et al. 2022

J Pediatr Intensive Care

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The purpose of this retrospective study was to investigate the effects of a single dose of aminophylline on urine output and fluid balance in children admitted to the cardiac intensive care unit. A retrospective study was performed to compare variables of interest before and 24 hours after aminophylline administration in children under the age of 18 years who were admitted to the cardiac intensive care unit at our institution from January 2011 onwards. Variables of interest included age, weight, aminophylline dose, concurrently administered diuretics, specific hemodynamic parameters, and blood urea nitrogen and creatinine levels. Variables such as urine output and fluid balance were measured through a binary endpoint. Data were compared in a paired fashion and continuous variables were compared through paired t-tests. Analyses were conducted using SPSS Version 23.0. A total of 14 patients were included in the study. There was no significant change in hemodynamic parameters or creatinine levels before and after intravenous aminophylline administration of 5 mg/kg. There was a significant difference in urine output, fluid balance, and blood urea nitrogen levels from the baseline value. Concurrent usage of diuretics did not show significant association with a difference in urine output or fluid balance from baseline. No significant adverse reactions were noted 24 hours after administration of aminophylline. Use of aminophylline dosed at 5 mg/kg is safe and leads to improvement in urine output and fluid balance without negatively impacting systemic oxygen delivery or renal filtration function.

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Section: Discussioncontrasting

confidence: 50%

The Effect of Aminophylline on Urine Output and Fluid Balance after a Single Dose in Children Admitted to the Pediatric Cardiac Intensive Care Unit

Loomba

Uppuluri

Chandra

et al. 2022

J Pediatr Intensive Care

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“…12 Other individual studies after pediatric cardiac surgery have also demonstrated some beneficial effects of interventions such as fenoldopam, aminophylline, dexmedetomidine, and enhanced oxygen delivery either by reduction in the risk of AKI or by allowing for enhanced diuresis without worsening kidney function. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30…”

Section: Discussionmentioning

confidence: 99%

Higher Dosage of Acetaminophen Associated with Lower Risk of Acute Kidney Injury after Pediatric Cardiac Surgery

Nater

Wong

Ikeda

et al. 2023

J Pediatr Intensive Care

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Acute kidney injury (AKI) after pediatric cardiac surgery is manifested by injury along multiple pathways. One of these is oxidative injury related to hemolysis and subsequent deposition of hemoglobin in the kidney. Acetaminophen inhibits hemoprotein-catalyzed lipid peroxidation associated with hemolysis and in turn, may attenuate renal injury. We performed a retrospective chart review of patients undergoing pediatric cardiac surgery. A randomized controlled trial previously performed dictated a regimented, high dosage, acetaminophen. A historical cohort who received ad hoc acetaminophen prior to that study and that met the same inclusion/exclusion criteria were also analyzed, as patients from that era were likely to have less acetaminophen administered. The patients were divided into those who developed AKI and those who did not and those groups were compared by total acetaminophen dose. Important inclusion criteria included age 3 months to 4 years who underwent cardiac surgery via midline sternotomy and were extubated within 3 hours of admission. Patients with preexisting or chronic kidney disease were excluded. A total of 181 patients were included. Of these, 69 (38%) developed AKI. There were no significant pre- or intraoperative risk differences in characteristics between those who developed AKI and those who did not. Acetaminophen dose did significantly differ between those who developed AKI and those who did not with lower acetaminophen dose in the AKI group (30 vs. 50 mg/kg, p-value = 0.01). A multivariate analysis was performed which found that higher acetaminophen dosage and lower immediate postoperative hemoglobin were independently associated with a lower risk of AKI. AKI occurs in ∼38% after pediatric cardiac surgery. Most often this is stage 1 AKI and resolves after a day. After adjusting for other covariables, higher acetaminophen dose may be associated with lower risk of AKI. This does not prove that acetaminophen given prospectively will reduce AKI. Further studies are needed.

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“…All types of white blood cells have different defensive and protective functions, and timely and sufficient white blood cells are beneficial to defense against diseases. Xanthine is a derivative of purine that is frequently used as a mild stimulant and bronchodilator [ 31 ], especially for treating asthma symptoms [ 32 ]. In our results, adenine and xanthine have been proven to be at abnormal levels, which may lead to many health problems.…”

Section: Discussionmentioning

confidence: 99%

Metabolite Comparison between Spleen‐Deficiency and Healthy Children

Liang

et al. 2023

Evidence-Based Complementary and Alternative Medicine

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Objective. From the perspective of metabolomics, this study compares the metabolomics characteristics of feces and urine between children with spleen-deficiency and healthy children to explain the scientific connotation of children with spleen-deficiency susceptibility to digestive system diseases from the metabolic level and provide a scientific basis for further research. Methods. This study included 20 children with spleen-deficiencies and 17 healthy children. Children’s symptom scores, height, and weight were recorded in groups, and feces and urine samples were collected. The samples were detected using ultrahigh-performance liquid chromatography-mass spectrometry. The data were analyzed using multivariate statistical analysis such as principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). Related differential metabolites were identified through database comparisons between two groups based on the MS and KEGG. Results. Compared to healthy children, the metabolites glucuronic acid, xanthine, and indole-3-acetaldehyde tend to be reduced in children with spleen-deficiency. Moreover, these children showed an increase in metabolites such as quinic acid, adenine, 4-methyl-5-thiazole-ethanol, 3-formyl indole, and 5-hydroxy indole-3-acetic acid. The condition affected many of the critical metabolic pathways, including the metabolism of tryptophan, cysteine, methionine, and pentose phosphate. Conclusion. The children with spleen-deficiency had disorders at the metabolic level, which might be due to factors such as diet, personal preferences, and genes, leading to various symptoms, making spleen-deficiency children more prone to suffer from digestive diseases than healthy children. The results set a basis for the research on children’s TCM constitution, which can be a reference to further studies to deal with the spleen-deficiency.

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Xanthine Derivatives for Kidney Protection in the Critically Ill Pediatric Population: A Systematic Review

Cited by 6 publications

References 17 publications

The Effect of Aminophylline on Urine Output and Fluid Balance after a Single Dose in Children Admitted to the Pediatric Cardiac Intensive Care Unit

The Effect of Aminophylline on Urine Output and Fluid Balance after a Single Dose in Children Admitted to the Pediatric Cardiac Intensive Care Unit

Higher Dosage of Acetaminophen Associated with Lower Risk of Acute Kidney Injury after Pediatric Cardiac Surgery

Metabolite Comparison between Spleen‐Deficiency and Healthy Children

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