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Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis

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Abstract

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.

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Sources of funding

There was no direct funding for this study. Dr. Downes was supported by the National Institute of Child Health and Human Development of the National Institutes of Health under award number 5T32HD069054, Cincinnati Training Program in Pediatric Clinical and Developmental Pharmacology. Dr. Harris receives funding from the Cystic Fibrosis Foundation (HARRIS12Q0). Dr. Clancy receives grant support from the NIH (NHLBI-FOA-HL 12–035) and the Cystic Fibrosis Foundation (R457-CR11, AMIN09YO). Dr. Goldstein is supported in part by the Agency for Healthcare Research and Quality Center for Education and Research on Therapeutics grant (AHRQ CERT 1U19HS021114). Dr. Askenazi receives funding from the Pediatric and Infant Center for Acute Nephrology (PICAN) which is sponsored by Children’s of Alabama and the University of Alabama at Birmingham’s School of Medicine, Department of Pediatrics and Center for Clinical and Translational Science (CCTS). Funding for REDCap at CCHMC is provided by Center for Clinical and Translational Science and Training grant support (UL1-RR026314). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

None.

Author information

Author notes

  1. Kevin J. Downes

    Present address: Division of Infectious Diseases, The Children’s Hospital of Philadelphia, 34th Street & Civic Center Boulevard, CHOP North, Suite 1409, Philadelphia, PA, 19104, USA

Authors and Affiliations

  1. Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Kevin J. Downes

  2. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Stuart L. Goldstein

  3. Division of Pulmonology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    John P. Clancy

  4. Biostatistics and Epidemiology, University of Cincinnati, Cincinnati, OH, USA

    Marepalli B. Rao

  5. College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    John P. Clancy & Stuart L. Goldstein

  6. Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA

    Neha R. Patil, Rajesh Koralkar & David J. Askenazi

  7. Division of Pulmonology, Children’s of Alabama, Birmingham, AL, USA

    William T. Harris

  8. Pediatric and Infant Center for Acute Nephrology (PICAN), Division of Nephrology, Children’s of Alabama, 1600 7th Ave South, Lowder Bldg 516, Birmingham, AL, 35233, USA

    David J. Askenazi

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  1. Kevin J. Downes
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Correspondence to David J. Askenazi.

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Downes, K.J., Patil, N.R., Rao, M.B. et al. Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis. Pediatr Nephrol 30, 1879–1888 (2015). https://doi.org/10.1007/s00467-015-3097-3

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  • DOI: https://doi.org/10.1007/s00467-015-3097-3

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