Authors (including presenting author) :
HUI WF(1),CHAN VPY(2),LOK VKW(2),TSE HK(2),WONG C(2),WONG SM(2),POON MH(2),HON KL(1)
Affiliation :
1: Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital
2: Department of Pharmacy, Hong Kong Children’s Hospital
Introduction :
Acute kidney injury (AKI) remains a serious concern for critically ill children in the Paediatric Intensive Care Unit (PICU). Among hospitalized children, nephrotoxic medications exposure is one of the most common cause of AKI. The identification of children most susceptible to drug –associated AKI, a potentially modifiable risk factor of AKI, would be useful in preventing AKI in these patients.
Objectives :
To assess the potential association on nephrotoxic medications exposure and the risk of developing AKI in critically ill children admitted to PICU of Hong Kong Children’s Hospital (HKCH).
Methodology :
This is a prospective cohort study. Patients were included if they were aged > 1month to ≤ 18 years of age and admitted to PICU of HKCH since 6/2020. The medication records from 14 days prior to PICU admission to PICU discharge were reviewed by an independent pharmacist to determine the nephrotoxic medications exposure in relation to the development of AKI.
Result & Outcome :
A total of 254 admissions fulfilling the study criteria were identified. The overall incidence of AKI during PICU stay was 41.4% (Stage 1: 18.1%; Stage 2: 14.2%; Stage 3: 9.1%). 68.9% of the patients were exposed to one or more of 43 nephrotoxic medications. Children receiving a higher number (2 vs 1 medications, p<0.001) or doses of nephrotoxic medications (27.5 vs 2.0 doses, p<0.001) are at a higher risk of AKI. Concomitant use of nephrotoxic medications was also associated with an increased risk of AKI. Furosemide, vancomycin and spironolactone were the three nephrotoxic medications with the highest total administered doses.
AKI was commonly encountered among critically ill children in PICU.
Critically ill children received a higher number, doses or a combination of nephrotoxic medications are at a higher risk of developing AKI. These patients should be monitored frequently and judicious use of nephrotoxic medications should be encouraged. An electronic renal drug dosage adjustment checking system will be developed based on these data to improve drug prescribing in AKI.
