Acetazolamide-Associated Acute Kidney Injury in Critically Ill Pediatric Patients

Abstract

OBJECTIVE Our objective was to determine the incidence and risk factors for intravenous acetazolamide-associated acute kidney injury (AKI). METHODS We utilized a retrospective cohort study including patients <19 years of age initiated on intravenous acetazolamide while admitted to an ICU. Data collection included patient demographics, clinical variables, acetazolamide dosing, and serum creatinine (SCr) values. Incidence of AKI was assessed per Kidney Disease Improving Global Outcomes criteria. Descriptive statistical analysis and ordinal logistic regression analysis were performed to determine the incidence of AKI and variables associated with AKI. RESULTS A total of 868 patients met study criteria (male 55.8%, median age 0.66 years [IQR 0.19, 3.0 years]). Intravenous acetazolamide was administered at 5.1 ± 2.8 mg/kg/dose for a median of 4 doses (IQR 2, 6). Median baseline SCr was 0.28 mg/dL (IQR 0.22, 0.37), corresponding to a creatinine clearance of 115 ± 55 mL/min/1.73 m2. Acute kidney injury occurred in 26.8% (n = 233) of patients (stage I = 20.1%, stage II = 3.7%, stage III 3.1%), and no patients received renal replacement therapy. An ordinal logistic regression model identified an increased odds of AKI with cyclosporine, ethacrynic acid, and piperacillin-tazobactam administration. CONCLUSIONS Acute kidney injury occurs frequently in critically ill pediatric patients receiving intravenous acetazolamide.

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

“…In small human trials, there is some evidence to suggest that acetazolamide ameliorates contrast-, cisplatin-, cardiopulmonary bypass-and rhabdomyolysis-induced AKI (Table 1) [62][63][64]109,110]. However, other clinical studies have demonstrated no beneficial effect or even induction of AKI with acetazolamide (Table 1) [65,66,111]. Acetazolamide-induced AKI was attributed to intra-tubular obstruction by acetazolamide-induced crystalluria in some of these populations [111].…”

Response to the Letter to the Editor “Preventing heme-induced nephropathy in children with glucose 6 phosphate dehydrogenase deficiency: is there a role for acetazolamide?”

“…Regarding the third question, the authors addressed a retrospective study reporting AKI in ICU patients after intravenous acetazolamide treatment [3]. These results may have occurred due to various inclusion criteria and the study design.…”