G238(P) Assessment of nephrotoxic medication associated acute kidney injury at a tertiary paediatric hospital

Background Research has shown that acute kidney injury (AKI) in the paediatric population is associated with significant morbidity as well as mortality. Primary renal pathology is no longer considered the most significant risk factor, with approximately 16% of AKI in America linked to nephrotoxic medication exposure. A recent quality improvement project (NINJA) at Cincinnati Children’s Hospital has shown that AKI rates can be reduced by implementation of interventions targeting nephrotoxic medication exposure. Aims This project aims to establish the burden of acute kidney injury related to nephrotoxic medications in a tertiary paediatric hospital. Through targeted quality improvement interventions, the study will aim to reduce the rate of AKI secondary to prescription of nephrotoxic medications. Methods In conjunction with pharmacists, a list of nephrotoxic medications was collated (table 1): Patients receiving an aminoglycoside for three or more days (Gentamicin, Tobramycin and Amikacin) and those on three nephrotoxic medications from the above table at the same time were identified. Blood test results were reviewed for evidence of AKI. In addition, the frequency of renal function testing was assessed, benchmarked against best practice guidelines defined by the NINJA study. Results Over a 37 day study period, 11 patients were identified as meeting the criteria for exposure to nephrotoxic medications. Of these patients, 1 developed an AKI. Creatinine was appropriately monitored every 3 days of treatment in 73% of patients. However, creatinine monitoring at 48 hours following the final dose was only completed in 9% of patients. Conclusions Within this study population, a significant proportion of patients were exposed to nephrotoxic medications and therefore, at risk of developing an AKI. Given the insufficient testing of creatinine, particularly 48 hours following nephrotoxic medication exposure, the burden of acute kidney injury may be underestimated. Targeted interventions are required to improve renal function monitoring in high-risk patients. Ultimately, this will allow earlier detection and therefore, treatment of acute kidney injury.