1136 Drug-induced acute kidney injury in non-critically ill, hospitalised children: a systematic review and meta-analysis

BackgroundNephrotoxic medication associated Acute Kidney Injury (NTMx-AKI) is a potentially preventable cause of AKI.ObjectivesWe conducted a systematic review to appraise the epidemiology of AKI in children, and here present results of a sub-review in non-critically ill, hospitalised children.MethodsTwo reviewers searched three electronic databases (EMBASE, MEDLINE and CINAHL) from January 2000 until November 2020. Eligible studies for this sub-review included in-hospital exposure to NTMx in non-critically ill children (0 to <18 years of age) with no diagnosis of kidney pathology, and reported AKI as an outcome.ResultsOf 205 publications identified, 21 met the inclusion criteria for the main systematic review, and five1–5 were included in this sub-review. Of these, two1,5 report AKI outcomes in all non-critically ill hospitalised patients (with and without nephrotoxin exposure), and three2–4 report outcomes only in those with nephrotoxin exposure. The pooled incidence of AKI in all non-critically ill, hospitalised children was 32% (p<0.00001, 95% CI 29–35%, pooled data from two papers1,5 (n=3088 patients)). Children with AKI were younger than those without (p=0.14, mean difference 3.10 years, 95% CI -7.22–1.01, pooled data from two papers1,5 (n=3088 patients)), however this association was not statistically significant. The pooled incidence of AKI in nephrotoxin-exposed, non-critically ill, hospitalised children was 17% (p<0.00001, 95% CI 15–19%, pooled data from three papers2–4 (n=747 patients2 combined with n=7756 nephrotoxin exposures3 4)). All papers considered nephrotoxin exposure as a risk factor for the development of AKI. However, there was insufficient homogeneity for meta-analysis. The data suggest that AKI prolongs hospital stay (p=0.14, mean difference 3.07 days, 95% CI -1.05–7.18, pooled data from two papers1,5 (n=3088 patients)), although this was not statistically significant. Mortality was only reported in one paper.1In-hospital mortality was higher in those with AKI (0.6%) than without (0.06%).ConclusionsAKI is common in non-critically ill, hospitalised children. Whilst meta-analysis did not produce significant findings, the data suggest that nephrotoxin exposure and younger age are risk factors for AKI. Children with AKI also had longer hospital stays and increased mortality.ReferencesMcGregor TL, Jones DP, Wang L, Danciu I, Bridges BC, Fleming GM, et al. Acute Kidney Injury Incidence in Noncritically Ill Hospitalized Children, Adolescents, and Young Adults: A Retrospective Observational Study. American Journal of Kidney Diseases 2016;67(3):384–90. Schaffzin JK, Dodd CN, Nguyen H, Schondelmeyer A, Campanella S, Goldstein SL. Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children. Hospital Pediatrics 2014;4(3):159–66. Goldstein SL, Dahale D, Kirkendall ES, Mottes T, Kaplan H, Muething S, et al. A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children. Kidney International 2020;97(3):580–8. Goldstein SL, Mottes T, Simpson K, Barclay C, Muething S, Haslam DB, et al. A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury. Kidney International 2016;90(1):212–221. Moffett BS, Goldstein SL. Acute kidney injury and increasing nephrotoxic-medication exposure in noncritically-ill children. Clinical journal of the American Society of Nephrology: CJASN 2011;6(4):856–63.