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Pediatric Drugs
Published in: Pediatric Drugs 1/2017

01-02-2017 | Original Research Article

Identifying High-Risk Medications Associated with Acute Kidney Injury in Critically Ill Patients: A Pharmacoepidemiologic Evaluation

Authors: Morgan B. Slater, Andrea Gruneir, Paula A. Rochon, Andrew W. Howard, Gideon Koren, Christopher S. Parshuram

Published in: Pediatric Drugs | Issue 1/2017

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Abstract

Background

Nephrotoxic medications are a common cause of acute kidney injury (AKI). Critically ill children receive more medication than other inpatients; however, the risk of nephrotoxic medication-induced AKI in these children is not well understood.

Objective

The aim of this study was to determine the association between exposure to nephrotoxic medications in the intensive care unit (ICU) and the development of AKI amongst critically ill children, adjusting for differences in underlying risk.

Methods

We conducted a nested case–control study among a cohort of patients admitted to a paediatric intensive care unit between January 2006 and June 2009. Cases were identified according to the RIFLE criteria. Using incidence density sampling, controls were matched 1:1 according to pre-ICU nephrotoxic drug exposure. Administration of nephrotoxic medications and other known risk factors of AKI were evaluated during the ICU stay prior to the diagnosis of AKI.

Results

A total of 914 patients in the cohort developed AKI and had an identifiable matched control. Eighty-seven percent of cases and 74% of controls were exposed to one or more nephrotoxic medications in the ICU during the study period. Furosemide (administered to 67.8% of patients), vancomycin (28.7%), and gentamicin (21.4%) were the most frequently administered nephrotoxic drugs. Patients who developed AKI were more likely to be exposed to at least one nephrotoxic medication and risk increased with increasing number of nephrotoxic medications. Ganciclovir (adjusted odds ratio [AOR] 4.7; 95% CI 1.7–13.0), furosemide (AOR 1.9; 95% CI 1.4–2.4), and gentamicin (AOR 1.8; 95% CI 1.4–2.4) significantly increased the odds of developing AKI after adjusting for underlying differences in risk factors of AKI.

Conclusion

This is the first study to assess the association between risk-adjusted nephrotoxic medication exposure and the development of AKI in critically ill children. Nephrotoxic medication exposure was common amongst children in the ICU and we found AKI was associated with the administration of specific drugs after adjustment for important risk factors.
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Metadata
Title
Identifying High-Risk Medications Associated with Acute Kidney Injury in Critically Ill Patients: A Pharmacoepidemiologic Evaluation
Authors
Morgan B. Slater
Andrea Gruneir
Paula A. Rochon
Andrew W. Howard
Gideon Koren
Christopher S. Parshuram
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
Pediatric Drugs / Issue 1/2017
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI
https://doi.org/10.1007/s40272-016-0205-1

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