Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis.
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.
Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, downeskj@email.chop.edu.
Kevin J
KJ
Downes
Neha R
NR
Patil
Marepalli B
MB
Rao
Rajesh
R
Koralkar
William T
WT
Harris
John P
JP
Clancy
Stuart L
SL
Goldstein
David J
DJ
Askenazi
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000293:Adolescent; D000617:Aminoglycosides / Q000008:administration & dosage / Q000009:adverse effects*; D003550:Cystic Fibrosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000617:Aminoglycosides