title: Drugs as risk factors of acute kidney injury in critically ill children.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a serious condition in critically ill children. Nephrotoxic medication exposure is a common contributing factor to AKI, but little literature is available in pediatrics. The aim of the present study was to assess potential associations between drugs and the risk of developing AKI.
  
  
  METHODS
  We performed a retrospective case-control study in a pediatric intensive care unit (PICU). Cases were patients who developed AKI during PICU stay. Patients without AKI served as controls and were matched to cases by age and gender in a one-to-one ratio.
  
  
  RESULTS
  One hundred case-control pairs were included. Cases were not statistically different from controls with regard to median weight and main diagnoses, but differed with regard to the need for mechanical ventilation, severity of illness, and median length of PICU stay. Multivariate models revealed a statistically significant higher risk of developing AKI for patients treated with metamizole, morphine, paracetamol, and tropisetron. A similar risk could be shown for medication groups, namely glucocorticoids, betalactam antibiotics, opioids, and non-steroidal anti-inflammatory drugs.
  
  
  CONCLUSIONS
  The results suggest that drugs are associated with acute renal dysfunction in critically ill children, but the multifactorial causes of AKI should be kept in mind.
authors.affiliation: Hospital Pharmacy, University Children's Hospital Zürich, Steinwiesstrasse 75, 8032, Zürich, Switzerland. pharma@kispi.uzh.ch.
authors.forename: Corina
authors.initials: C
authors.lastname: Glanzmann
authors.affiliation: Department of Intensive Care and Neonatology, University Children's Hospital Zürich, Steinwiesstrasse 75, 8032, Zürich, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Frey
authors.affiliation: Hospital Pharmacy, University Children's Hospital Zürich, Steinwiesstrasse 75, 8032, Zürich, Switzerland.
authors.forename: Priska
authors.initials: P
authors.lastname: Vonbach
authors.affiliation: Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, 4031, Basel, Switzerland.|Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Meier
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Case-control; Children; Intensive care; Medication exposure; Nephrotoxic; Renal insufficiency