ESPN 51th Annual Meeting

ESPN 2018


 
USE OF NEPHROTOXIC MEDICATION AND ACUTE KIDNEY INJURY (AKI) WITHIN 100 DAYS AFTER PEDIATRIC ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION (ALLO-HSCT)
KAROLIS AZUKAITIS 1 JUSTINAS DARASKEVICIUS 1 MILDA PECIULYTE 1 RUTA PLANCIUNAITE 1 JUSTINA DZIUGEVICIUTE-TUPKO 1 GODA VAITKEVICIENE 1 JELENA RASCON 1 AUGUSTINA JANKAUSKIENE 1

1- CLINIC OF PEDIATRICS, INSTITUTE OF CLINICAL MEDICINE, FACULTY OF MEDICINE, VILNIUS UNIVERSITY, VILNIUS, LITHUANIA
 
Introduction:

Allo-HSCT is a challenging procedure often associated with the use of multiple potentially nephrotoxic medications, including therapeutic and prophylactic antimicrobials and cyclosporine A (CyA). The higher target levels of CyA in the early post allo-HSCT period could result in increased risk of AKI development. 

Material and methods:

Retrospective chart review of pediatric patients who underwent allo-HSCT at Vilnius University Hospital Santaros Clinics during 2011-2017. pRIFLE criteria with serum creatinine based glomerular filtration rate (eGFR) estimations were used for AKI definition with only patients with pRIFLE stage I or higher considered. The use of nephrotoxic medications was recorded until first AKI episode or for the first 100 days, in case of no AKI. Median CyA levels and coefficient of variation (CV) in first 30 days were calculated per patient.

Results:

A total of 45 patients (68.9% boys) with a median (IQR) age of 10 (2-13) years underwent allo-HSCT. 24 (53.3%) patients experienced severe AKI within 100 days after allo-HSCT. Median CyA concentration within first 30 days was 123.7 (95.5-178.8) µg/L and 123.9 (108.9-152.9) µg/L in patients with and without AKI, respectively (p=0.9). Median CyA CV during first 30 days was 37.9% (28.9-106.2) and 36.5% (33.5-57.9) (p=0.99), respectively. The use of antiviral, antifungal and antibacterial drugs was comparable in both groups (table). 

 

No AKI (n=21)

AKI (n=24)

P value

Aciclovir

19 (90.48%)

24 (100%)

0.21

Ganciclovir

3 (14.29%)

3 (12.5%)

1

Foscarnet

1 (4.76%)

1 (4.17%)

1

Cidofovir

4 (19.05%)

2 (8.33%)

0.4

Gentamicin

1 (4.76%)

0

0.47

Amikacin

6 (28.57%)

5 (20.83%)

0.73

Vancomycin

3 (14.29%)

5 (20.83%)

0.71

Amphotericin B

15 (71.43%)

17 (70.83%)

0.96

 

 

 

 

 

 

 

Conclusions:

The rates of nephrotoxic antimicrobial medication use did not differ in patients with and without AKI. Patients who experienced AKI had comparable CyA levels and variation during the first month after allo-HSCT.