Daily serum creatinine monitoring promotes earlier detection of acute kidney injury in children and adolescents with cystic fibrosis.
BACKGROUND
The epidemiology of aminoglycoside-associated acute kidney injury (AG-AKI) has not been well described in pediatric patients with cystic fibrosis (CF). We aimed to assess the impact of daily serum creatinine (SCr) measurement on detection of AG-AKI at our institution.


METHODS
We examined a cohort of hospitalized patients with CF who received an intravenous (IV) aminoglycoside for ≥ 3 days. We compared the rate, timing, and medical management surrounding detection of AG-AKI during 2 periods: January 2010-May 2011 (Era 1, SCr measured at the discretion of the medical team, N=124) and June 2011-June 2012 (Era 2, SCr measured daily, N=103). Our primary outcome was detection of AG-AKI defined as ≥ 50% increase in SCr from baseline (lowest value in prior 6 months), or ≥ 0.3mg/dL rise within 48 h, occurring after day 2.


RESULTS
The use of once daily tobramycin (p=0.02) and IV fluids (p<0.001) was higher during Era 2, while AG courses were shorter (p=0.04), and fewer concomitant nephrotoxins (p=0.04) were given; higher daily tobramycin doses (p<0.001) were administered. Although the rate of AG-AKI was not significantly different (12% during Era 1 vs. 20% during Era 2, p=0.09), the number of AG-AKI days detected increased (5.5 vs. 2.9 per 100 AG days, p=0.003), and detection occurred earlier (median 6 vs. 9 days, log rank test p=0.02) during the daily SCr period.


CONCLUSIONS
Daily SCr measurement promoted earlier and increased detection of AG-AKI in patients with CF at our institution. We suggest systematic evaluation for AKI during aminoglycoside administration in patients with CF.
Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: kevin.downes@cchmc.org.
Kevin J
KJ
Downes
Biostatistics and Epidemiology, University of Cincinnati, Cincinnati, OH, USA.
Marepalli B
MB
Rao
Division of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Laurie
L
Kahill
The Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Hovi
H
Nguyen
Division of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
John P
JP
Clancy
The Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Stuart L
SL
Goldstein
D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D000293:Adolescent; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D003404:Creatinine / Q000097:blood*; D003550:Cystic Fibrosis / Q000097:blood / Q000188:drug therapy*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007677:Kidney Function Tests; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
D000617:Aminoglycosides; D003404:Creatinine
Acute kidney injury; Aminoglycosides; Cystic fibrosis; Drug monitoring; Tobramycin