title: Initial experience using aminophylline to improve renal dysfunction in the pediatric cardiovascular ICU.
abstract: OBJECTIVE
  To determine if aminophylline administration is associated with improved creatinine clearance and greater urine output in children with acute kidney injury in the cardiovascular ICU.
  
  
  METHODS
  Single-center retrospective cohort study.
  
  
  METHODS
  Pediatric cardiovascular ICU, university-affiliated children's hospital.
  
  
  METHODS
  Children with congenital or acquired heart disease in the cardiovascular ICU who received aminophylline to treat oliguric acute kidney injury and fluid overload.
  
  
  METHODS
  Patients received aminophylline after consultation with a pediatric nephrologist. Data were collected retrospectively over 7 days to assess if aminophylline was associated with improvement in creatinine clearance, urine output, and fluid overload.
  
  
  RESULTS
  Thirty-one patients received 52 aminophylline courses. Over the 7-day study period, serum creatinine decreased from a mean of 1.13 ± 0.91 to 0.87 ± 0.83 mg/dL (-0.05 mg/dL/d, p < 0.001). A concomitant increase was seen in estimated glomerular filtration rate from a mean of 50.0 ± 30.0 to 70.6 ± 58.1 mL/min/1.73 m (+3.66 mL/min/1.73 m/d, p < 0.001). Average daily urine output increased by 0.22 mL/kg/hr (p < 0.001), and fluid overload decreased on average by 0.42% per day in the 7-day study period (p = 0.005). Although mean furosemide dose increased slightly (0.12 mg/kg/d, p = 0.01), hydrochlorothiazide dosing did not significantly change over the study period. There were no complications related to aminophylline administration.
  
  
  CONCLUSIONS
  Our study suggests that aminophylline therapy may be associated with significantly improved renal excretory function and may augment urine output in children who experience oliguric acute kidney injury in the cardiovascular ICU. Additionally, we did not identify any aminophylline-related side effects in this high-risk cardiac population. Future prospective studies are necessary to confirm the safety profile and to ensure that the beneficial effects are independent of other clinical interventions.
authors.affiliation: 1Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA. 2Institute for Global Health and Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA. 3Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: David M
authors.initials: DM
authors.lastname: Axelrod
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Anglemyer
authors.forename: Sara F
authors.initials: SF
authors.lastname: Sherman-Levine
authors.forename: Aihua
authors.initials: A
authors.lastname: Zhu
authors.forename: Paul C
authors.initials: PC
authors.lastname: Grimm
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sutherland
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000503:physiopathology* / Q000652:urine; D000628:Aminophylline / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood / Q000652:urine; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006331:Heart Diseases / Q000150:complications / Q000628:therapy; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009846:Oliguria / Q000188:drug therapy / Q000209:etiology; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D004232:Diuretics; D010726:Phosphodiesterase Inhibitors; D006852:Hydrochlorothiazide; D000628:Aminophylline; D005665:Furosemide; D003404:Creatinine