Colleen Cloyd, PharmD, BCPPS
Advanced Patient Care Pharmacist
Nationwide Children's Hospital
Columbus, Ohio
Disclosure information not submitted.
Mahmoud Abdel-Rasoul, MS, MPH
Mr
Nationwide Children's Hospital
Columbus, Ohio, United States
Disclosure information not submitted.
Title: Comparison of Estimated Glomerular Filtration Rate to Aminoglycoside Clearance in PICU Patients
INTRODUCTION: Aminoglycoside antibiotics are commonly used in the pediatric intensive care unit (PICU). They are freely filtered across the glomerulus, are not reabsorbed by the kidney, and are not appreciably eliminated through another pathway in the body. Due to these characteristics, the clearance of aminoglycosides (AGC), as calculated using pharmacokinetic data, may represent an alternative way to estimate renal function in critically ill children in the PICU.
Methods: A query of the medical record system between 2015 and 2020 was performed for all patients who received at least 1 dose of an extended-interval aminoglycoside administered in the PICU and who had two post-dose drug levels resulted. Clinical information related to renal function and dosing histories for aminoglycosides were obtained from the day the aminoglycoside was administered. Pharmacokinetic parameters were used to calculate an aminoglycoside clearance rate and the Bedside Schwartz equation was used to calculate an eGFR (eGFR from BS). Pearson correlations and paired t-tests were performed to assess the relationship between AGC and eGFR from BS using SAS Version 9.4.
Results: Eighty patients ages newborn to 18 years (median 7.8 years) were assessed. AGC moderately and positively correlated with eGFR from BS (r=0.49, p=< 0.0001) and the eGFR from BS was usually higher than AGC (p=< 0.0001, t=-8.03, DF=79). In patients less than 1 year old (n=22), eGFR from BS correlated strongly with AGC (r=0.76, p=< 0.0001).
Conclusions: The clearance of aminoglycoside antibiotics may represent another helpful assessment of renal function in critically ill children. We hypothesize this may be especially useful in young children < 1 year old and in children for which creatinine is not an accurate measure of renal function. Further studies comparing AGC to other measures of renal function, such as 24-hour urine collection or radionuclide clearance is warranted to further describe this association.