Sameer Thadani
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Brady Moffett, PharmD
Mr
Texas Children's Hospital, United States
Disclosure information not submitted.
Ayse Akcan-Arikan, MD
Assoc Prof of Pediatrics, Medical Dir of Critical Care Nephrology
Baylor College of Medicine at Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Title: Nephrotoxic Medication Exposure in Children on Continuous Renal Replacement Therapy
Introduction: Continuous renal replacement therapy (CRRT) is the primary modality for support of severe acute kidney injury (AKI) in critically ill children. Nephrotoxic (NTX) medication exposure can precipitate and worsen AKI; yet little is known about NTX use in pediatric CRRT patients. We aim to assess the burden of NTX exposures in pediatric patients immediately before and on CRRT and explored the association with Major Adverse Kidney Outcomes at 60 days (MAKE60).
Methods: Single-center cohort study of pediatric CRRT patients between 2/2014 and 2/2020. The medications categorized as nephrotoxins were Diuretics (Furosemide, Chlorothiazide, Bumetanide), Chemotheurepudics (Cisplatin, Methotrexate), Antivirals (Foscarnet, Acyclovir, Ganciclovir), Aminoglycosides (Amikacin, Gentamicin), NSAIDs (Ketorolac, Ibuprofen), Calcineurin inhibitors (Tacrolimus, Cyclosporine), Antifungals (Amphotericin), Contrast (Iothalamate), Antibiotics (Vancomycin, Piperacilin/Tazobactam), Anti-epileptics (Fosphenytoin, Phenytoin), and ACE inhibitors (Lisinopril, Enalapril).PRE NTX exposure was from ICU admission to CRRT start, DURING was from CRRT start to CRRT end.
Results: 300 patients, 53% male, median age 62 months (IQR13-159) were included. PELOD-2 at ICU admission and CRRT start were 6 (IQR3-8) and 8 (IQR6-10). CRRT duration was 11 days (IQR3-24). 47% of patients have > 1 NTX exposure PRE while 30% had > 1 NTX during CRRT. Eight percent of patients had > 3 NTX exposures PRE and DURING. 44% and 22% of patients received diuretics PRE and DURING, respectively. Antibiotics were prescribed PRE 25% and DURING 34%. Neither NTX exposure PRE (OR 1.12, 95% CI 0.88- 1.43) or DURING CRRT (OR 1.3, 95% CI 0.99- 1.76)) nor any specific class of NTX was associated with MAKE 60.
Conclusions: While common and largely driven by diuretic and antimicrobials, NTX exposures PRE CRRT or during CRRT were not associated with MAKE-60 in pediatric patients. Outcome associations in different vulnerable groups, such as oncology and transplant need to be further explored to provide insight into potentially actionable modifiable exposure risk.