Acute Kidney Injury Associated with High Nephrotoxic Medication Exposure Leads to Chronic Kidney Disease after 6Â Months

ObjectiveTo assess the development of chronic kidney disease (CKD) after high nephrotoxic medication exposure-associated acute kidney injury (NTMx-AKI) in hospitalized children.Study designWe performed a retrospective cohort study of children exposed to an aminoglycoside for ≥3 days or ≥3 nephrotoxic medications simultaneously for the development of CKD at 6 months. Follow-up data >6 months after acute kidney injury (AKI) were retrieved from electronic health records. Outcomes in children with NTMx-AKI were compared with patients of same age and primary service distribution who were exposed to nephrotoxic medications but did not develop AKI (controls).ResultsOne hundred patients with NTMx-AKI were assessed (mean age of 9.3 ± 6.9 years). Commonly involved services were bone marrow transplantation/oncology (59%), liver transplantation (13%), and pulmonary (13%). Pre-AKI estimated glomerular filtration rate (eGFR) was 119 ± 14.5 mL/min/1.73 m2 (range 90-150 mL/min/1.73 m2). Mean discharge eGFR was 105.1 ± 27.1 mL/min/1.73 m2. At 6 months after NTMx-AKI, eGFR (n = 77) was 113.8 ± 30.6 mL/min/1.73 m2. Sixteen (20.7%) had eGFR of 60-90, 2 (2.6%) had eGFR <60, and 9 (11.6%) had eGFR >150 mL/min/1.73 m2 (hyperfiltration). Twenty-four (68.5%) of 35 patients who were assessed for proteinuria had a urine protein-to-creatinine ratio >0.3 mg/mg, and 29 (37.6%) had hypertension. Twenty-six (33.7%) patients had CKD (proteinuria or eGFR <60 mL/min/1.73 m2). An additional 28 (36.3%) were considered to be at risk for CKD with hypertension, eGFR between 60 and 90 mL/min/1.73 m2, or eGFR >150 mL/min/1.73 m2. CKD, hypertension, and proteinuria were more common in the AKI cohort than in controls.ConclusionsSix months after NTMx-AKI, 70% of patients had evidence of residual kidney damage (reduced eGFR, hyperfiltration, proteinuria, or hypertension). Few underwent a complete evaluation for CKD. With studies showing an association between AKI and CKD, we suggest systematic comprehensive follow-up in children after NTMx-AKI.