Frequency of Exposure of Nephrotoxic Drugs and Drug-Induced Acute Kidney Injury in Pediatric Intensive Care Unit: A Retrospective Review From a Tertiary Care Centre in Pakistan

Ahmed, Rahim Ali; Shahzad, Muhammad; Umer, Anum; Azim, Asim; Jamil, Muhammad Tariq; Haque, Anwar Ul

doi:10.7759/cureus.12183

Cited by 2 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During their chemotherapy, all patients were hydrated sufficiently according to their body surface area (BSA) as recommended in their treatment protocols (2400–3000 mL/m 2 /d of prespecified solution). Diuretics were used as defined in their treatment protocol (i.e., mannitol for platinum compounds and furosemide for other chemotherapeutic agents), and blood levels of additional nephrotoxic medication (i.e., vancomycin, certomycin, gentamicin, amphotericin) were closely monitored [ 12 ]. All patients had completed their treatment at least one year before kidney evaluation.…”

Section: Methodsmentioning

confidence: 99%

Prospective Evaluation of Kidney Function in Long-Term Survivors of Pediatric CNS Tumors

Stepien

Handler²,

Gojo

et al. 2022

Current Oncology

View full text Add to dashboard Cite

Purpose: Numerous acute effects of chemotherapeutics on kidney function are well described. However, data on the long-term effects of chemotherapy in the growing population of childhood central nervous system (CNS) tumor survivors is limited. We aimed to evaluate the kidney function of a cohort of long-term CNS tumor survivors treated with different standard chemotherapeutic regimens. Methods: Patients treated for a CNS tumor were prospectively evaluated up to 12 years after completion of their therapy. Examination of kidney function was performed during routine follow-up visits. Blood pressure and blood and urine parameters were analyzed for kidney function evaluation. Glomerular function was assessed by calculating the estimated glomerular filtration rate (eGFR), tubular functions were analyzed by measuring serum electrolytes, bicarbonate and phosphate reabsorption, and proteinuria was assessed by calculating the protein/creatinine ratio and phosphate reabsorption. Results: None of the 65 patients evaluated suffered from clinically relevant kidney impairment (eGFR < 90 mL/min/L, 73 m2). There was no association between chemotherapy dose and eGFR. Only two patients showed mild signs of tubulopathy and 11 patients were diagnosed with elevated blood pressure. Conclusion: With adequate supportive measures, such as sufficient hydration according to chemotherapy protocol guidelines, as well as avoidance or close monitoring of additional nephrotoxic medication, impaired kidney function is rare in CNS tumor survivors treated with standard chemotherapy. Nonetheless, long-term follow-up is essential for early detection of mild impairment of kidney function.

show abstract

Section: Methodsmentioning

confidence: 99%

Prospective Evaluation of Kidney Function in Long-Term Survivors of Pediatric CNS Tumors

Stepien

Handler²,

Gojo

et al. 2022

Current Oncology

View full text Add to dashboard Cite

show abstract

“…Ahmed and colleagues conducted a retrospective cross-sectional study in the pediatric ICU to assess potential associations between nephrotoxic drugs and the risk of developing AKI. They reported vancomycin as the most common single nephrotoxin, a combination of vancomycin and colistin as dual nephrotoxic agents, and vancomycin, colistin, and amphotericin B as a triple nephrotoxic combination [24]. The authors analyzed the drugs with known nephrotoxic activities rather than all possible administered drugs.…”

Section: Plos Onementioning

confidence: 99%

Drug-drug interaction and acute kidney injury development: A correlation-based network analysis

Zhu

Barreto

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Background Drug-induced nephrotoxicity is a relatively common preventable cause of acute kidney injury (AKI), providing early recognition and management. The pharmacokinetics or pharmacodynamics of drug-drug interactions may lead to additive or synergistic toxicity. The influx of new medications or off-label use of medications in the critical care setting can lead to additional nephrotoxicities, often challenging to predict or detect. This study evaluates the patterns of medication utilization, their combinations, and the related associations with AKI. Methods We utilized correlation-based network analysis (CNA) to investigate the relationship between medications or their combinations with AKI in a large cohort of critically ill patients in a tertiary medical center between 2007 and 2018. Pairwise medication-AKI correlation analysis was performed to evaluate drug synergistic or additive effects. To investigate the inherent nephrotoxicity of medications, we further analyzed medications that were not paired with any other medications within 24 hours before or after their administration time (isolated medication analysis). Results Among 147,289 ICU admissions, we identified 244 associations among 1,555 unique medication types. In pairwise analysis, 233 significant correlations were found among 13,150,198 medication pair instances. In isolated medication analysis, ten significant AKI associations were noted. When stratified by eGFR level, substantial differences between eGFR<90 vs. eGFR≥90 patients were observed. This highlights a need to determine eGFR as a risk factor for nephrotoxicity assessment when drug interactions are considered. Conclusions This large-scale cohort study identified an artificial intelligence model to identify patient-agnostic relationships between medication or their pairs with AKI incidence among critically ill patients. It could be used as a continuous quality assurance tool to monitor drug-associated risk nephrotoxicity.

show abstract

Frequency of Exposure of Nephrotoxic Drugs and Drug-Induced Acute Kidney Injury in Pediatric Intensive Care Unit: A Retrospective Review From a Tertiary Care Centre in Pakistan

Cited by 2 publications

References 17 publications

Prospective Evaluation of Kidney Function in Long-Term Survivors of Pediatric CNS Tumors

Prospective Evaluation of Kidney Function in Long-Term Survivors of Pediatric CNS Tumors

Drug-drug interaction and acute kidney injury development: A correlation-based network analysis

Contact Info

Product

Resources

About