Division of Nephrology, McGill University Health Centre, Montreal, Canada.
Nephrol Dial Transplant. 2011 Jan;26(1):144-50. doi: 10.1093/ndt/gfq375. Epub 2010 Jun 29.
Aminoglycosides (AG) cause acute kidney injury (AKI), but the incidence and severity distribution are unclear, particularly in non-critically ill children. We determined the incidence, severity and risk factors of AG-associated AKI and assessed for associations with longer hospitalization and higher costs.
At Texas Children's Hospital, we conducted a retrospective cohort study of children treated with AG for ≥ 5 days in 2005, excluding children with admission primary renal diagnoses. AKI was defined by the paediatric Risk, Injury, Failure, Loss, End Stage Kidney Disease (pRIFLE) and Acute Kidney Injury Network (AKIN) definitions. Multiple logistic and linear regression analyses were used to assess independence of associations with outcomes.
Five hundred and fifty-seven children [mean ± SD age = 8.0 ± 5.9 years, 286 (51%) male, 489 (88%) gentamicin] were studied. The AKI rate was 33% and 20% by pRIFLE and AKIN definitions, respectively. Longer treatment, higher baseline estimated glomerular filtration rate, being on a medicine (versus surgical) treatment service and prior AG treatment were independent risk factors for AKI development. AKI by pRIFLE or AKIN was independently associated with longer hospital stay and higher total hospital costs. The pRIFLE definition was more sensitive for AKI detection, but the AKIN definition was more strongly related to outcomes.
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.
氨基糖苷类（AG）会导致急性肾损伤（AKI），但其发病率和严重程度分布尚不清楚，尤其是在非危重症儿童中。我们确定了 AG 相关 AKI 的发病率、严重程度和危险因素，并评估了其与住院时间延长和费用增加的关系。
在德克萨斯儿童医疗中心，我们对 2005 年接受 AG 治疗≥5 天的儿童进行了回顾性队列研究，排除了入院时存在原发性肾脏疾病的儿童。AKI 定义为儿科风险、损伤、衰竭、损失、终末期肾病（pRIFLE）和急性肾损伤网络（AKIN）定义。使用多变量逻辑和线性回归分析来评估与结局的相关性是否独立。
共纳入 557 例儿童[平均年龄±标准差为 8.0±5.9 岁，286 例（51%）为男性，489 例（88%）为庆大霉素]。pRIFLE 和 AKIN 定义的 AKI 发生率分别为 33%和 20%。更长的治疗时间、更高的基线估计肾小球滤过率、接受药物（而非手术）治疗服务和既往 AG 治疗是 AKI 发生的独立危险因素。pRIFLE 或 AKIN 定义的 AKI 与住院时间延长和总住院费用增加独立相关。pRIFLE 定义对 AKI 的检测更敏感，但 AKIN 定义与结局的相关性更强。
在接受 AG 治疗的非危重症儿童中，AKI 很常见，并与不良结局相关。未来的研究应尝试了解如何在非危重症儿科环境中最好地定义 AKI。
