Association between Nephrotoxic Drug Combinations and Acute Kidney Injury in the Neonatal Intensive Care Unit.
Association between Nephrotoxic Drug Combinations and Acute Kidney Injury in the Neonatal Intensive Care Unit.
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DOI：
10.1016/j.jpeds.2020.08.035
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Gonzalez D
中科院分区：
文献类型：
--
作者：
Salerno SN;Liao Y;Jackson W;Greenberg RG;McKinzie CJ;McCallister A;Benjamin DK;Laughon MM;Sanderson K;Clark RH;Gonzalez D
目的：确定268个由儿科医疗集团管理的新生儿重症监护病房（NICUs）中暴露于肾毒性药物组合的婴儿急性肾损伤（AKI）的发生率。我们纳入了出生在22-36周孕周，出生后≤120天，暴露于肾毒性药物组合，血清肌酐测量可用，并在2007年至2016年期间出院的婴儿。为了确定基于肾脏疾病的AKI血清肌酐定义相关的危险因素：改善全球结局标准，我们对胎龄、性别、出生体重、出生后年龄、种族/民族、败血症、呼吸窘迫综合征、基线血清肌酐和联合用药持续时间进行了多变量logistic和Cox回归校正。对比庆大霉素+吲哚美辛对以下肾毒性药物组合的调整后AKI发生率：氯噻嗪+布洛芬；氯噻嗪+吲哚美辛；速尿+庆大霉素；速尿+布洛芬；速尿+妥布霉素；布洛芬+螺内酯；万古霉素+哌拉西林-他唑巴坦。在8286例纳入的婴儿中，1384例（17%）发生AKI。在多变量分析中，脓毒症、较低的基线肌酐和联合治疗的持续时间与AKI的发生率增加相关。在多变量和Cox回归模型中，与庆大霉素+吲哚美辛相比，呋塞米+妥布霉素和万古霉素+哌拉西林-他唑巴坦与AKI风险降低相关。在这个队列中，接受较长时间肾毒性联合治疗的婴儿发生AKI的几率增加。
To determine the incidence of acute kidney injury (AKI) in infants exposed to nephrotoxic drug combinations admitted to 268 neonatal intensive care units (NICUs) managed by the Pediatrix Medical Group. We included infants born at 22-36 weeks gestational age, ≤120 days postnatal age, exposed to nephrotoxic drug combinations, with serum creatinine measurements available, and discharged between 2007 and 2016. To identify risk factors associated with a serum creatinine definition of AKI based on the Kidney Disease: Improving Global Outcomes criteria, we performed multivariable logistic and Cox regression adjusting for gestational age, sex, birth weight, postnatal age, race/ethnicity, sepsis, respiratory distress syndrome, baseline serum creatinine, and duration of combination drug exposure. The adjusted odds of AKI were determined relative to gentamicin + indomethacin for the following nephrotoxic drug combinations: chlorothiazide + ibuprofen; chlorothiazide + indomethacin; furosemide + gentamicin; furosemide + ibuprofen; furosemide + tobramycin; ibuprofen + spironolactone; vancomycin + piperacillin-tazobactam. Among 8,286 included infants, 1384 (17%) experienced AKI. On multivariable analysis, sepsis, lower baseline creatinine, and duration of combination therapy were associated with increased odds of AKI. Furosemide + tobramycin and vancomycin + piperacillin-tazobactam were associated with a decreased risk of AKI relative to gentamicin + indomethacin in both the multivariable and Cox regression models. In this cohort, infants receiving longer durations of nephrotoxic combination therapy had an increased odds of developing AKI.
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DOI：
10.1016/s2352-4642(17)30069-x
发表时间：
2017-11
期刊：
The Lancet. Child & adolescent health
影响因子：
--
作者：
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影响因子：
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DOI：
10.1136/archdischild-2015-308459
发表时间：
2016-05-01
影响因子：
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作者：
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Spigarelli, Michael G.