@article{ref1,
title="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",
journal="Curēus",
year="2020",
author="Ahmed, Rahim and Shahzad, Muhammad and Umer, Anum and Azim, Asim and Jamil, Muhammad Tariq and Haque, Anwar",
volume="12",
number="12",
pages="e12183-e12183",
abstract="Introduction Acute kidney injury (AKI) is one of the most common problems seen in the pediatric intensive care unit (PICU), with an overall 27% incidence. Besides many other factors, nephrotoxic medications (Nephrotoxins; Ntx) are also responsible for a large proportion of potentially avoidable pediatric AKI, directly accounting for 16% of AKI events. <br><br>OBJECTIVE To assess potential associations between nephrotoxic drugs and the risk of developing AKI in children admitted in PICU. Material and methods This is a retrospective cross-sectional study. Children (aged 1 month - 18 years) admitted to the PICU, with a length of stay >24 hours, were included. AKI was defined as according to KDIGO (Kidney Disease Improving Global Outcomes) criteria. Mild AKI was defined as a rise in creatinine value of 0.3 mg/dl from presenting value at a 24-hour interval. Patients were grouped according to the presence or absence of AKI. All medications administered in the ICU were assessed for nephrotoxicity through a review of adverse reactions mentioned in the Pediatric Dosage Handbook, along with consultation with a clinical pharmacist. <br><br>RESULTS Among 752 patients, the mean age was 4.8 years ± 4.37. There were 57.3% male and 42.7% female children. Among the exposed children, 37.4% received one drug, 32.4% received two drugs and 12.1% had high nephrotoxin exposure. The most commonly used drug was vancomycin (16.8%), as a single Ntx; vancomycin/colistin (12.9%), in dual nephrotoxic combination; and vancomycin/colistin/amphotericin (2.9%) in highly exposed children (i.e., with equal or more than three). Overall, the incidence of AKI was 14.9%. <br><br>CONCLUSION Nephrotoxins are potentially avoidable risk factors in critically ill children. Whenever a combination of medications is required, it's advisable to review all medications for better protection of kidneys and preventing of acute kidney injury.<p /> <p>Language: en</p>",
language="en",
issn="2168-8184",
doi="10.7759/cureus.12183",
url="http://dx.doi.org/10.7759/cureus.12183"
}