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Drug-induced kidney injury in Chinese critically ill pediatric patients

Biwen Hu1, Ling Ye1, Tong Li1

  • 1Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.

Frontiers in Pharmacology
|October 13, 2022
PubMed

Insights

Drug-induced acute kidney injury (DIKI) in critically ill children is often linked to specific medications. Furosemide, midazolam, albumin, fentanyl, glycyrrhizin, vancomycin, and milrinone were identified as high-risk drugs.

Area of Science:

  • Pediatric Nephrology
  • Clinical Pharmacology
  • Critical Care Medicine

Background:

  • Drug-induced acute kidney injury (DIKI) is a recognized adverse drug reaction, yet its prevalence and specific drug associations in pediatric populations remain under-investigated.
  • The Pediatric Intensive Care database (PIC) provides a valuable resource for studying DIKI in critically ill children.

Purpose of the Study:

  • To investigate the incidence and identify key drugs associated with DIKI in Chinese pediatric patients admitted to the intensive care unit.
  • To assess the relationship between specific drug exposures and the occurrence of DIKI using established causality assessment scales.

Main Methods:

  • Patients with acute kidney injury (AKI) were identified using KDIGO criteria from the PIC database.
  • The Naranjo scale was employed to assess the causality of DIKI for suspected drugs.
  • Propensity score matching (PSM) was utilized to control for confounders including age, gender, hospital stay duration, and primary diagnosis.
  • Unconditional logistic regression analysis was performed to determine significant associations between drug exposure and DIKI.

Main Results:

  • A total of 81 pediatric patients with DIKI were identified, with 238 drugs administered 1,863 times.
  • Seven drugs were significantly associated with DIKI after analysis: furosemide injection (p=0.001), midazolam injection (p=0.001), 20% albumin prepared from human plasma injection (p=0.004), fentanyl citrate injection (p=0.001), compound glycyrrhizin injection (p=0.026), vancomycin hydrochloride for intravenous (p=0.010), and milrinone lactate injection (p=0.009).

Conclusions:

  • Critically ill pediatric patients exhibit a higher risk of developing DIKI when exposed to specific medications.
  • Furosemide, midazolam, albumin, fentanyl, glycyrrhizin, vancomycin, and milrinone are identified as key drugs requiring careful monitoring for potential nephrotoxicity in this vulnerable population.

Keywords:
acute kidney injurydrug-induced kidney injurypediatricsrational drug userational medication

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