Impact of the use of nephrotoxic drugs in critically ill pediatric patients

Abstract Objective: To evaluate the association between the use of nephrotoxic drugs and acute kidney injury in critically ill pediatric patients. Methods: This was a retrospective cohort study involving all children admitted to the intensive care unit of a pediatric hospital during a 1-year period. Acute kidney injury was defined according to the KDIGO classification. Patients with a length of hospital stay longer than 48 hours and an age between 1 month and 14 years were included. Patients with acute or chronic nephropathy, uropathy, congenital or acquired heart disease, chronic use of nephrotoxic drugs, rhabdomyolysis and tumor lysis syndrome were excluded. Patients were classified according to the use of nephrotoxic drugs during their stay at the pediatric intensive care unit. Results: The sample consisted of 226 children, of whom 37.1% used nephrotoxic drugs, 42.4% developed acute kidney injury, and 7.5% died. The following drugs, when used alone, were associated with acute kidney injury: acyclovir (p < 0.001), vancomycin (p < 0.001), furosemide (p < 0.001) and ganciclovir (p = 0.008). The concomitant use of two or more nephrotoxic drugs was characterized as an independent marker of renal dysfunction (p < 0.001). After discharge from the pediatric intensive care unit, renal function monitoring in the ward was inadequate in 19.8% of cases. Conclusion: It is necessary for intensivist physicians to have knowledge of the main nephrotoxic drugs to predict, reduce or avoid damage to their patients.

**摘要**
**研究目的**：评估重症儿科患者使用肾毒性药物（nephrotoxic drugs）与急性肾损伤（acute kidney injury）之间的相关性。
**研究方法**：本研究为一项回顾性队列研究（retrospective cohort study），纳入了某儿童医院重症监护病房1年内收治的所有儿童。急性肾损伤参照KDIGO（改善全球肾脏病预后组织，Kidney Disease: Improving Global Outcomes）分级标准进行定义。纳入标准为住院时长超过48小时、年龄介于1月龄至14岁之间的患儿。排除标准包括合并急性或慢性肾病（nephropathy）、尿路疾病（uropathy）、先天性或获得性心脏病、长期使用肾毒性药物、横纹肌溶解症（rhabdomyolysis）以及肿瘤溶解综合征（tumor lysis syndrome）的患儿。研究根据患儿在儿科重症监护病房住院期间的肾毒性药物使用情况进行分组。
**研究结果**：本研究共纳入226名儿童，其中37.1%的患儿使用了肾毒性药物，42.4%发生了急性肾损伤，7.5%的患儿死亡。单独使用以下药物时与急性肾损伤存在显著关联：阿昔洛韦（acyclovir，p < 0.001）、万古霉素（vancomycin，p < 0.001）、呋塞米（furosemide，p < 0.001）以及更昔洛韦（ganciclovir，p = 0.008）。同时使用两种及以上肾毒性药物是肾功能不全的独立危险因素（p < 0.001）。在从儿科重症监护病房转出至普通病房后，19.8%的病例未得到充分的肾功能监测。
**研究结论**：重症监护医师（intensivist physicians）需掌握主要肾毒性药物的相关知识，以预测、减轻或避免对患者造成肾损伤。