Original ArticleAcute Kidney Injury Associated with High Nephrotoxic Medication Exposure Leads to Chronic Kidney Disease after 6 Months
Section snippets
Methods
We performed a retrospective cohort study of patients exposed to NTMx in a non–critical care setting at Cincinnati Children's Hospital Medical Center (Cincinnati, Ohio) from June 2011 to June 2012 (Figure 1; available at www.jpeds.com). Study patients were identified through a hospital-wide quality improvement project using our electronic health record (Epic, Verdona, Wisconsin) to identify prospectively all children with high-NTMx exposure outside critical care units. We excluded neonates and
Results
Data from the first 100 patients who developed NTMx-AKI were analyzed. Baseline characteristics for all patients with AKI including demographics, primary service, pRIFLEmax, and baseline eGFR are listed in Table III. Ninety-nine patients with NTMx-AKI had a SCr available 6 months before the AKI episode. The mean eGFR before the AKI episode was 119.2 ± 14.5 mL/min/1.73 m2; all patients had eGFR between 90 and 150 mL/min/1.73 m2. Additionally, 15 patients had an evaluation of proteinuria before
Discussion
Our study shows that patients are not consistently followed postdischarge after an NTMx-AKI episode. Although most survivors were seen in a hospital clinic 6 months postdischarge, very few were seen by a nephrologist. NTMx-AKI has traditionally been thought to be transient, but our data show that 70% survivors of NTMx-AKI had ≥1 sign of renal injury (proteinuria, reduced eGFR, hyperfiltration, or hypertension), and nearly 30% had ≥2 signs.
Only 13.2% of adult patients see a nephrologist within
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S.M. was sponsored in the Cincinnati Children's Hospital Medical Center's Acute Care Nephrology Fellowship (through a grant from Gambro Renal Products, Inc). S.G. and H.N. were supported by the Agency for Healthcare Research and Quality (1U19HS021114). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The authors declare no conflicts of interest.