miércoles, 25 de marzo de 2015

Daily serum creatinine monitoring promotes earlier detection of acu... - PubMed - NCBI

Daily serum creatinine monitoring promotes earlier detection of acu... - PubMed - NCBI

 2014 Jul;13(4):435-41. doi: 10.1016/j.jcf.2014.03.005. Epub 2014 Apr 6.

Daily serum creatinine monitoring promotes earlier detection of acute kidney injury in children and adolescents with cystic fibrosis.



The epidemiology of aminoglycoside-associated acute kidney injury (AG-AKI) has not been well described in pediatric patients with cystic fibrosis (CF). We aimed to assess the impact of daily serum creatinine (SCr) measurement on detection of AG-AKI at our institution.


We examined a cohort of hospitalized patients with CF who received an intravenous (IV) aminoglycoside for ≥ 3 days. We compared the rate, timing, and medical management surrounding detection of AG-AKI during 2 periods: January 2010-May 2011 (Era 1, SCr measured at the discretion of the medical team, N=124) and June 2011-June 2012 (Era 2, SCr measured daily, N=103). Our primary outcome was detection of AG-AKI defined as ≥ 50% increase in SCr from baseline (lowest value in prior 6 months), or ≥ 0.3mg/dL rise within 48 h, occurring after day 2.


The use of once daily tobramycin (p=0.02) and IV fluids (p<0.001) was higher during Era 2, while AG courses were shorter (p=0.04), and fewer concomitant nephrotoxins (p=0.04) were given; higher daily tobramycin doses (p<0.001) were administered. Although the rate of AG-AKI was not significantly different (12% during Era 1 vs. 20% during Era 2, p=0.09), the number of AG-AKI days detected increased (5.5 vs. 2.9 per 100 AG days, p=0.003), and detection occurred earlier (median 6 vs. 9 days, log rank test p=0.02) during the daily SCr period.


Daily SCr measurement promoted earlier and increased detection of AG-AKI in patients with CF at our institution. We suggest systematic evaluation for AKI during aminoglycoside administration in patients with CF.
Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.


Acute kidney injury; Aminoglycosides; Cystic fibrosis; Drug monitoring; Tobramycin

[PubMed - indexed for MEDLINE] 
 [Available on 2015-07-01]

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