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Use of Aminophylline to Reverse Acute Kidney Injury in Pediatric Critical Care Patients
Laura J Radel1, Joshua Branstetter2, Tamekia L Jones3
1Department of Pediatric Cardiology (LJR, MBM, SDT), Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN.
Insights
Aminophylline may help reverse acute kidney injury (AKI) in critically ill children. This study found increased urine output in patients treated with aminophylline, suggesting its potential as a rescue therapy for pediatric AKI.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Pharmacology
Background:
- Acute kidney injury (AKI) affects a significant portion of pediatric critical care patients, increasing morbidity and mortality.
- Aminophylline has been investigated for AKI treatment, but existing research presents conflicting outcomes.
- This study addresses the need for clarity on aminophylline's efficacy in pediatric AKI.
Purpose of the Study:
- To evaluate the effectiveness of aminophylline in reversing acute kidney injury (AKI) in critically ill pediatric patients.
- To determine if aminophylline administration leads to improved renal function markers in this population.
Main Methods:
- A retrospective chart review was conducted at a single institution.
- Pediatric inpatients diagnosed with AKI and treated with aminophylline between January 2016 and December 2018 were included.
- Data were collected for a 5-day period surrounding aminophylline administration.
Main Results:
- Out of 17 patients (19 therapies), 12 showed resolution of AKI during the study.
- A significant increase in urine output (19%) was observed the day after initiating aminophylline in resolving cases (p = 0.0063).
- Trends indicated decreased serum creatinine and reduced inotropic support requirements.
Conclusions:
- Aminophylline shows potential as a rescue therapy for acute kidney injury (AKI) in critically ill children.
- Limitations include a small sample size and the retrospective design.
- Further investigation with larger, randomized controlled trials is recommended to confirm efficacy.
Objective:
Acute kidney injury (AKI) is a complication encountered in 18% to 51% of pediatric critical care patients admitted for treatment of other primary diagnoses and is an independent risk factor for increased morbidity and mortality. Aminophylline has shown promise as a medication to treat AKI, but published studies have shown conflicting results. Our study seeks to assess the reversal of AKI following the administration of aminophylline in critically ill pediatric patients.
Methods:
We performed a single-institution retrospective chart review of pediatric inpatients who were diagnosed with AKI and subsequently treated with non-continuous dose aminophylline between January 2016 and December 2018. Data were collected beginning 2 days prior to the initial dose of aminophylline through completion of the 5-day aminophylline course.
Results:
Nineteen therapies among 17 patients were included in analysis. Twelve of the therapies resulted in resolution of AKI during the study period. We observed urine output increase of 19% (p = 0.0063) on the day following initiation of aminophylline therapy in the subset of patients whose AKI resolved. Trends toward decreased serum creatinine and lower inotropic support were also noted.
Conclusions:
Based on these findings, aminophylline could be considered a potentially effective medication for use as rescue therapy in critically ill children with AKI. Limitations include small study population and retrospective nature. Further research in this area with a larger study population and a randomized control trial would allow for better characterization of the efficacy of aminophylline in reversal of AKI.
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