Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis.

TitleRisk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis.
Publication TypeJournal Article
Year of Publication2015
AuthorsDownes KJ, Patil NR, Rao MB, Koralkar R, Harris WT, Clancy JP, Goldstein SL, Askenazi DJ
JournalPediatr Nephrol
Date Published2015 Oct
KeywordsAcute Kidney Injury, Adolescent, Aminoglycosides, Cystic Fibrosis, Female, Follow-Up Studies, Humans, Incidence, Injections, Intravenous, Male, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, United States, Young Adult

BACKGROUND: Aminoglycoside (AG) therapy is a common cause of acute kidney injury (AKI) in cystic fibrosis (CF) patients. The aim of this study was to identify factors associated with AKI during intravenous AG courses in this population.

METHODS: This was a matched case-control study utilizing two independent cohorts of hospitalized CF patients receiving ≥ 3 days of intravenous AG at Cincinnati Children's Hospital Medical Center and Children's of Alabama. All admissions with AKI (cases, N = 82) were matched to two randomly selected admissions without AKI (controls, N = 164) by center, gender, and age ±3 years of the case. AKI was defined as a 1.5-fold increase in the baseline serum creatinine (SCr) level or by an increase in SCr level of 0.3 mg/dL within 48 h. Admissions with AKI before day 4 or without at least weekly SCr monitoring were excluded from the analysis. Factors were compared between cases and controls using simple and multiple conditional logistic regression.

RESULTS: Multivariable analysis identified receipt of an AG within 90 days prior to admission, longer duration of AG therapy, low serum albumin, and receipt of trimethoprim/sulfamethoxazole as independent risk factors for developing AKI. Infection with Staphylococcus aureus diminished the odds of developing AKI.

CONCLUSIONS: This study identifies risk factors contributing to AG-associated AKI in CF patients. These findings can be used to anticipate high-risk scenarios and limit AKI in CF patients under clinical care.

Alternate JournalPediatr. Nephrol.
PubMed ID25912993
PubMed Central IDPMC4576343
Grant List1U19HS021114 / HS / AHRQ HHS / United States
5T32HD069054 / HD / NICHD NIH HHS / United States
HL 12-035 / HL / NHLBI NIH HHS / United States
T32 HD069054 / HD / NICHD NIH HHS / United States
UL1 TR001425 / TR / NCATS NIH HHS / United States
UL1-RR026314 / RR / NCRR NIH HHS / United States