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Aminoglycoside ototoxicity in pediatric patients receiving long-term peritoneal dialysis
1Division of Nephrology, Children's Mercy Hospital, Kansas City, Missouri 64108.
Insights
Children on peritoneal dialysis face ototoxicity risks from aminoglycoside (AG) therapy. Intravenous AG poses a higher risk than intraperitoneal AG, necessitating careful monitoring of hearing function.
Area of Science:
- Pediatric Nephrology
- Ototoxicology
- Auditory Neuroscience
Background:
- Aminoglycoside (AG) antibiotics are crucial for treating infections in children undergoing long-term peritoneal dialysis (PD).
- Otototoxicity is a known side effect of AG therapy, but its specific impact on children with PD requires further investigation.
Purpose of the Study:
- To evaluate the risk of ototoxicity in children on long-term peritoneal dialysis receiving aminoglycoside therapy.
- To compare the ototoxic effects of intravenous versus intraperitoneal AG administration in this patient population.
Main Methods:
- Pure-tone audiometry (PTA) and auditory brainstem response (ABR) were used for baseline and follow-up auditory evaluations in 14 children and 7 controls.
- Vestibular testing was conducted in a subset of patients.
- Auditory function was assessed before and after intraperitoneal AG therapy.
Main Results:
- Children on PD had poorer baseline auditory function at high frequencies (6.0 and 8.0 kHz) compared to controls.
- Four patients (28%) developed hearing loss, primarily those with a history of intravenous AG therapy.
- No hearing loss was observed in patients receiving only intraperitoneal AG or with no prior AG exposure (P < 0.005).
- PTA was more sensitive than ABR in detecting hearing abnormalities.
Conclusions:
- Children on peritoneal dialysis are at risk for aminoglycoside-induced ototoxicity.
- Intraperitoneal AG administration may be associated with lower ototoxicity risk than intravenous administration, warranting further research.
- Close monitoring of AG levels and auditory function is essential for all children on PD receiving AG therapy, regardless of administration route.
Abstract:
We evaluated 14 children on long-term peritoneal dialysis for ototoxicity associated with aminoglycoside (AG) therapy. Baseline evaluation of all patients and 7 controls included pure-tone audiometry (PTA) and click-evoked auditory brain stem response (ABR). Nine patients had repeat PTA and ABR evaluations and vestibular testing 1 year after study entry. Five patients had an additional assessment following intraperitoneal AG therapy. The baseline auditory function of the patients was significantly poorer than controls at 6.0 and 8.0 kHz by PTA (P < 0.05), whereas the results of ABR testing were not different. Of the 14 patients, 4 (28%) had hearing loss, 3 of whom had a history of intravenous AG therapy. In contrast, none of the patients who received intraperitoneal AG therapy only, or without a history of AG therapy, had hearing loss (P < 0.005). There was no evidence of progressive loss of hearing acuity with time or associated with intraperitoneal AG therapy. One patient had findings of vestibular dysfunction. We conclude that children receiving peritoneal dialysis are at risk of AG ototoxicity. While intraperitoneal administration of AG may be associated with less ototoxicity than intravenous administration, further study is necessary to verify this finding and close monitoring of AG levels remains mandatory irrespective of the route of administration. PTA rather than click-evoked ABR appears to be the best indicator of abnormal hearing acuity in this population.