Impact of the use of nephrotoxic drugs in critically ill pediatric patients.

Autor: Almeida JP; Unidade de Terapia Intensiva Pediátrica, Hospital Pequeno Príncipe - Curitiba (PR), Brasil., João PRD; Unidade de Terapia Intensiva Pediátrica, Hospital Pequeno Príncipe - Curitiba (PR), Brasil., Sylvestre LC; Serviço de Nefrologia Pediátrica, Hospital Pequeno Príncipe - Curitiba (PR), Brasil.
Jazyk: Portuguese; English
Zdroj: Revista Brasileira de terapia intensiva [Rev Bras Ter Intensiva] 2020 Oct-Dec; Vol. 32 (4), pp. 557-563.
DOI: 10.5935/0103-507X.20200093
Abstrakt: Objective: To evaluate the association between the use of nephrotoxic drugs and acute kidney injury in critically ill pediatric patients.
Methods: This was a retrospective cohort study involving all children admitted to the intensive care unit of a pediatric hospital during a 1-year period. Acute kidney injury was defined according to the KDIGO classification. Patients with a length of hospital stay longer than 48 hours and an age between 1 month and 14 years were included. Patients with acute or chronic nephropathy, uropathy, congenital or acquired heart disease, chronic use of nephrotoxic drugs, rhabdomyolysis and tumor lysis syndrome were excluded. Patients were classified according to the use of nephrotoxic drugs during their stay at the pediatric intensive care unit.
Results: The sample consisted of 226 children, of whom 37.1% used nephrotoxic drugs, 42.4% developed acute kidney injury, and 7.5% died. The following drugs, when used alone, were associated with acute kidney injury: acyclovir (p < 0.001), vancomycin (p < 0.001), furosemide (p < 0.001) and ganciclovir (p = 0.008). The concomitant use of two or more nephrotoxic drugs was characterized as an independent marker of renal dysfunction (p < 0.001). After discharge from the pediatric intensive care unit, renal function monitoring in the ward was inadequate in 19.8% of cases.
Conclusion: It is necessary for intensivist physicians to have knowledge of the main nephrotoxic drugs to predict, reduce or avoid damage to their patients.
Databáze: MEDLINE
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