Introduction:
Nephrotoxic medication exposure is a significant contributor to acute kidney injury (AKI) in hospitalized children, leading to increased costs and prolonged hospital stays. When children receive three or more nephrotoxic medications on the same day, the risk of AKI doubles. In certain instances, the damage caused by nephrotoxic medications can be permanent, leading to chronic kidney disease. To address this issue, Goldstein and colleagues developed the Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) program, aimed at reducing nephrotoxic medication exposure and preventing AKI in children. The aim of this study to assess the prevalence of nephrotoxic medication exposure in non critically ill children per 1000 patient-days of hospitalization and prevalance of nephrotoxic AKI in those exposed children
Methods:
This prospective study aimed to assess nephrotoxic medication exposure and development of nephrotoxic AKI in non-critically ill hospitalized children (1month-12 years). Baseline kidney function was measured, and serum creatinine was monitored during and after drug exposure ends. AKI was defined by KDIGO criteria. When AKI occurred, nephrotoxic medications were replaced with less harmful alternatives.
Results:
In this study, 3,264 children were included. The most common reasons for hospitalization were bronchopneumonia (29.4%), acute gastroenteritis (26.0%), and tropical fever (22.4%). Exposure to nephrotoxic medications (NTMx) was seen in 3.1% of cases, with NTMx exposure prevalence rate of 5.02 per 1000 patient days. Most of the hospitalized non-critically ill children exposed to NTMx were aged between 3 and 12 years (58.4%). Gender distribution among those exposed was nearly equal, with males comprising 51.5%. The intensity of medication exposure showed that 70.3% were exposed to one nephrotoxic medication, while 29.7% were exposed to two, with an AKI prevalence of 5.94 % among these patients. With the substitution of non nephrotoxic drugs, AKI resolved within 11±4 days. Among that nephrotoxic drugs exposed children, 17.8% had high nephrotoxic drug exposure. The most frequently administered nephrotoxic drugs included vancomycin (38.6%), acyclovir (26.7%), and amikacin (17.8%). Serum creatinine monitoring rates among the nephrotoxic drug exposed babies were 100% till day7, after which monitoring rates gradually falls and it was only 55 % at day 17.
Conclusions:
Our study shows that nephrotoxic medications exposure in non critically ill child was minimum. Nephrotoxic AKI prevalence rate in our study was also low. Most common nephrotoxic drugs used were Vancomycin, Acyclovir and Amikacin.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.