Ahmed Rahim, Shahzad Muhammad, Umer Anum, Azim Asim, Jamil Muhammad Tariq, Haque Anwar
Pediatric Intensive Care Unit, The Indus Hospital, Karachi, PAK.
Pediatrics, The Indus Hospital, Karachi, PAK.
Cureus. 2020 Dec 20;12(12):e12183. doi: 10.7759/cureus.12183.
Introduction Acute kidney injury (AKI) is one of the most common problems seen in the pediatric intensive care unit (PICU), with an overall 27% incidence. Besides many other factors, nephrotoxic medications (Nephrotoxins; Ntx) are also responsible for a large proportion of potentially avoidable pediatric AKI, directly accounting for 16% of AKI events. Objective To assess potential associations between nephrotoxic drugs and the risk of developing AKI in children admitted in PICU. Material and methods This is a retrospective cross-sectional study. Children (aged 1 month - 18 years) admitted to the PICU, with a length of stay >24 hours, were included. AKI was defined as according to KDIGO (Kidney Disease Improving Global Outcomes) criteria. Mild AKI was defined as a rise in creatinine value of 0.3 mg/dl from presenting value at a 24-hour interval. Patients were grouped according to the presence or absence of AKI. All medications administered in the ICU were assessed for nephrotoxicity through a review of adverse reactions mentioned in the Pediatric Dosage Handbook, along with consultation with a clinical pharmacist. Results Among 752 patients, the mean age was 4.8 years ± 4.37. There were 57.3% male and 42.7% female children. Among the exposed children, 37.4% received one drug, 32.4% received two drugs and 12.1% had high nephrotoxin exposure. The most commonly used drug was vancomycin (16.8%), as a single Ntx; vancomycin/colistin (12.9%), in dual nephrotoxic combination; and vancomycin/colistin/amphotericin (2.9%) in highly exposed children (i.e., with equal or more than three). Overall, the incidence of AKI was 14.9%. Conclusion Nephrotoxins are potentially avoidable risk factors in critically ill children. Whenever a combination of medications is required, it's advisable to review all medications for better protection of kidneys and preventing of acute kidney injury.
引言
急性肾损伤（AKI）是儿科重症监护病房（PICU）中最常见的问题之一，总体发病率为27%。除许多其他因素外，肾毒性药物（肾毒素；Ntx）也在很大比例的潜在可避免的儿科AKI中起作用，直接导致16%的AKI事件。
目的
评估肾毒性药物与入住PICU的儿童发生AKI风险之间的潜在关联。
材料与方法
这是一项回顾性横断面研究。纳入入住PICU、住院时间>24小时的儿童（年龄1个月至18岁）。AKI根据KDIGO（改善全球肾脏病预后组织）标准定义。轻度AKI定义为肌酐值在24小时间隔内较初始值升高0.3mg/dl。根据是否存在AKI对患者进行分组。通过查阅《儿科剂量手册》中提及的不良反应并咨询临床药剂师，评估ICU中使用的所有药物的肾毒性。
结果
在752例患者中，平均年龄为4.8岁±4.37。男性儿童占57.3%，女性儿童占42.7%。在暴露儿童中，37.4%接受一种药物，32.4%接受两种药物，12.1%有高肾毒素暴露。最常用的药物是万古霉素（16.8%），作为单一肾毒素；万古霉素/黏菌素（12.9%），用于双重肾毒性联合用药；在高暴露儿童（即使用三种或更多种药物）中，万古霉素/黏菌素/两性霉素（2.9%）。总体而言，AKI的发生率为14.9%。
结论
肾毒素是危重症儿童潜在可避免的风险因素。每当需要联合用药时，建议对所有药物进行评估，以更好地保护肾脏并预防急性肾损伤。
