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Acute kidney injury during a pediatric sickle cell vaso-occlusive pain crisis

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Abstract

Background

Patients who develop sickle cell disease (SCD) nephropathy are at a high risk for mortality. The pathophysiology of vaso-occlusive pain crisis may contribute to acute kidney injury (AKI). Non-steroidal anti-inflammatory drugs, known inducers of AKI, are used to treat pain crises. Multiple gaps exist in the knowledge about the impact of AKI in SCD.

Methods

We conducted a 2-year retrospective review of AKI events in patients admitted for vaso-occlusive crisis. AKI was defined by an increase of ≥0.3 mg/dL or 50% in serum creatinine from baseline. Laboratory values and ketorolac administration by days and dose (mg/kg) were identified from hospital records. A generalized mixed effects model for binary outcomes evaluated AKI based on laboratory variables and ketorolac administration. A generalized mixed Poisson effects model analyzed the association of AKI with hospital length of stay.

Results

Thirty-three out of 197 admissions for vaso-occlusive pain crisis (17%) were associated with AKI. Fifty-two percent of the cases presented to the Emergency Room (ER) with AKI. Every one unit decrease in hemoglobin from baseline to admission increased the risk of AKI by 49%. Among patients who received ketorolac for pain, both total days and doses of ketorolac were associated with AKI. Finally, patients with pain and AKI required longer periods of hospitalization than patients without AKI.

Conclusion

Acute kidney injury during sickle cell pain crisis is common and may be an important modifiable risk factor for developing chronic kidney disease (CKD). Further studies are needed to determine the impact of nephrotoxic medications on progressive SCD nephropathy.

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Acknowledgements

The authors would like to acknowledge the NIH (5K23HL127100) and American Society of Hematology Scholar award for funding the ongoing cohort. The authors acknowledge PICAN and NIH funded UAB-UCSD O’Brien Center for AKI research (P30 DK079337) and the UAB Pediatric Research Office for support of this study. The authors would like to thank the participants living with sickle cell disease for volunteering for this study. The authors would like to thank the additional members of the Pediatric Sickle Cell team (Christina Bemrich-Stolz, MD, MSPH, Kristen Osborn CRNP, Susan Dobbins, CRNP, Heather Carlton, CRNP, Michelle Alleman CRNP, Lindsey Thomason, CRNP, and the SCD clinic nurses) for providing excellent care and assisting with obtaining laboratory measurements.

Authors’ contributions

SB collected data, wrote the first draft of the manuscript, and participated in analysis and editing of the final manuscript, IA supervised statistical analysis and edited the final manuscript. LH, TH, DA critically reviewed and edited the manuscript, JL designed the study and supervised editing of the drafts.

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Authors and Affiliations

  1. Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA

    Sujatha Baddam, Lee Hilliard, Thomas Howard & Jeffrey D. Lebensburger

  2. Department of Biostatistics, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA

    Inmaculada Aban

  3. Pediatric Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 512, Birmingham, AL, 35233, USA

    David Askenazi

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  1. Sujatha Baddam
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Correspondence to Jeffrey D. Lebensburger.

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Ethics statement

The institutional review board at the University of Alabama at Birmingham approved this retrospective review of AKI during vaso-occlusive pain crisis (VOC).

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The authors have no relevant conflicts of interest.

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Baddam, S., Aban, I., Hilliard, L. et al. Acute kidney injury during a pediatric sickle cell vaso-occlusive pain crisis. Pediatr Nephrol 32, 1451–1456 (2017). https://doi.org/10.1007/s00467-017-3623-6

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  • DOI: https://doi.org/10.1007/s00467-017-3623-6

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