Year: 2014
Type: dissertation
Study design: Observational Study
Abstract: Background: Kidney injury is a common adverse event in critically ill children and has a complex and multifactorial etiology. Some factors, such as age and sex, are non-modifiable while others, including medication exposure, are modifiable and present an opportunity to decrease the risk of kidney injury. The objective of this dissertation was to quantify the risk of acute kidney injury (AKI) attributable to the initiation of nephrotoxic medications among critically ill children.Methods: We utilized a pharmacoepidemiologic approach, using AKI as a model for studying adverse drug events (ADEs) in children. First, we conducted a systematic review of the application of an accepted definition of AKI (the RIFLE criteria) in children. Second, we estimated the incidence and associated factors of AKI in a 3.5-year cohort of critically ill children. Finally, we conducted a nested case-control study to quantify the risk of developing AKI after the initiation of one or more nephrotoxic medications.Results: Our systematic review identified wide variation in the application of the RIFLE. We found an AKI incidence of 23.7% in our patient population and identified patients at increased risk for the development of AKI. Administration of nephrotoxic medications during ICU admission was the single greatest risk factor for AKI. We found a high incidence of nephrotoxic medication use in the ICU; over 80% of patients were exposed to one or more nephrotoxic medications. The administration of ganciclovir, furosemide and gentamicin were significantly associated with increased odds of developing AKI before and after adjustment for underlying differences in risk factors of AKI.Conclusion: Acute kidney injury is common among critically ill children. Nephrotoxic medication exposure preceding AKI is common. The results of this work can help to optimize prescribing and aid clinicians in making optimal treatment choices, reducing harm and improving patient outcomes.
Source: TSpace (University of Toronto)
Author: Morgan Slater
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2567195131