609: NEPHROTOXIC MEDICATIONS AND THEIR ASSOCIATION WITH ACUTE KIDNEY INJURY IN CRITICALLY ILL CHILDREN

Introduction: The incidence of developing acute kidney injury (AKI) in the pediatric intensive care unit (PICU) is estimated to be 26% (Kaddourah, 2017). Nephrotoxic medications are a modifiable risk factor associated with AKI in non-critically ill children & neonates (Moffett, 2011 & Stoops, 2019). The primary objective of this study is to evaluate the association between the number of nephrotoxic medications and the risk of developing AKI in critically ill children. Methods: This is a single center retrospective cohort study of critically ill children admitted to a tertiary care PICU. Inclusion criteria was patients age 0-21 years admitted for >24 hours. Exclusion criteria was history of chronic kidney disease or if expired within 24 hours of admission. We considered the same list of medications used in previous studies to be nephrotoxic, NSAIDs, certain antibiotics, and chemotherapy agents. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria including serum creatinine increase by ≥0.3, >1.5 times baseline, or urine output < 0.5 mL/kg/hr for ≥12 hours. Severe AKI was defined as Stage 2 & 3 AKI. Exposure to the number of nephrotoxic medications and development of AKI was analyzed. Results: 60 patients were analyzed. Median age was 6.55 (1.12-12.71) years and mostly male (55%). Median LOS was 3 (2-5) days. Majority had a respiratory illness as primary diagnosis (31%). Median PELOD2 score was 3.5 (2-7). Incidence of AKI was 40%. 46% of patients who developed AKI did not have any nephrotoxic medications administered. 42% of patients with AKI were administered 1 nephrotoxic medication. 12% of patients with AKI had exposure to ≥2 medications. Amongst all patients with AKI, 88% had severe AKI. The most common medications administered were ibuprofen (22%) and vancomycin (17%). Exposure to the number of nephrotoxic medications and development of AKI was assessed with Fisher’s Exact test. There was no statistical significance with the number of nephrotoxic medications and the development of AKI (p=0.962). Correlation analysis revealed an increased rate of AKI with PICU LOS ≥5 days (p=0.029). Conclusions: There was no statistically significant association between the number of nephrotoxic medications and the development of AKI. Patients with longer LOS had a higher risk of developing AKI.