Association between Nephrotoxic Drug Combinations and Acute Kidney Injury in the Neonatal Intensive Care Unit - 17/12/20
Abstract |
Objective |
To determine the incidence of acute kidney injury (AKI) in infants exposed to nephrotoxic drug combinations admitted to 268 neonatal intensive care units managed by the Pediatrix Medical Group.
Study design |
We included infants born at 22-36 weeks gestational age, ≤120 days postnatal age, exposed to nephrotoxic drug combinations, with serum creatinine measurements available, and discharged between 2007 and 2016. To identify risk factors associated with a serum creatinine definition of AKI based on the Kidney Disease: Improving Global Outcomes criteria, we performed multivariable logistic and Cox regression adjusting for gestational age, sex, birth weight, postnatal age, race/ethnicity, sepsis, respiratory distress syndrome, baseline serum creatinine, and duration of combination drug exposure. The adjusted odds of AKI were determined relative to gentamicin + indomethacin for the following nephrotoxic drug combinations: chlorothiazide + ibuprofen; chlorothiazide + indomethacin; furosemide + gentamicin; furosemide + ibuprofen; furosemide + tobramycin; ibuprofen + spironolactone; and vancomycin + piperacillin-tazobactam.
Results |
Among 8286 included infants, 1384 (17%) experienced AKI. On multivariable analysis, sepsis, lower baseline creatinine, and duration of combination therapy were associated with increased odds of AKI. Furosemide + tobramycin and vancomycin + piperacillin-tazobactam were associated with a decreased risk of AKI relative to gentamicin + indomethacin in both the multivariable and Cox regression models.
Conclusions |
In this cohort, infants receiving longer durations of nephrotoxic combination therapy had an increased odds of developing AKI.
Il testo completo di questo articolo è disponibile in PDF.Keywords : neonates, drug-drug interactions, acute kidney injury
Abbreviations : AKI, NICU, VLBW
Mappa
| S.S. was supported by the National Institute of General Medical Sciences and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number 5T32GM086330. M.L. received research support from the National Heart, Lung, and Blood Institute (1K24HL143283). D.G. received research support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5K23HD083465). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.G. has received support from industry for research services (conflict-of-interest/). The other authors declare no conflicts of interest. |
Vol 228
P. 213-219 - gennaio 2021 Ritorno al numero
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