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Initial Experience Using Aminophylline to Improve Renal Dysfunction in the Pediatric Cardiovascular ICU

Axelrod, David M. MD1; Anglemyer, Andrew T. PhD, MPH2; Sherman-Levine, Sara F. CPNP1; Zhu, Aihua MD1; Grimm, Paul C. MD3; Roth, Stephen J. MD, MPH1; Sutherland, Scott M. MD3

Pediatric Critical Care Medicine: January 2014 - Volume 15 - Issue 1 - p 21–27
doi: 10.1097/01.pcc.0000436473.12082.2f
Cardiac Intensive Care

Objective: To determine if aminophylline administration is associated with improved creatinine clearance and greater urine output in children with acute kidney injury in the cardiovascular ICU.

Design: Single-center retrospective cohort study.

Setting: Pediatric cardiovascular ICU, university-affiliated children’s hospital.

Patients: Children with congenital or acquired heart disease in the cardiovascular ICU who received aminophylline to treat oliguric acute kidney injury and fluid overload.

Interventions: Patients received aminophylline after consultation with a pediatric nephrologist. Data were collected retrospectively over 7 days to assess if aminophylline was associated with improvement in creatinine clearance, urine output, and fluid overload.

Measurements and Main Results: Thirty-one patients received 52 aminophylline courses. Over the 7-day study period, serum creatinine decreased from a mean of 1.13 ± 0.91 to 0.87 ± 0.83 mg/dL (–0.05 mg/dL/d, p < 0.001). A concomitant increase was seen in estimated glomerular filtration rate from a mean of 50.0 ± 30.0 to 70.6 ± 58.1 mL/min/1.73 m2 (+3.66 mL/min/1.73 m2/d, p < 0.001). Average daily urine output increased by 0.22 mL/kg/hr (p < 0.001), and fluid overload decreased on average by 0.42% per day in the 7-day study period (p = 0.005). Although mean furosemide dose increased slightly (0.12 mg/kg/d, p = 0.01), hydrochlorothiazide dosing did not significantly change over the study period. There were no complications related to aminophylline administration.

Conclusions: Our study suggests that aminophylline therapy may be associated with significantly improved renal excretory function and may augment urine output in children who experience oliguric acute kidney injury in the cardiovascular ICU. Additionally, we did not identify any aminophylline-related side effects in this high-risk cardiac population. Future prospective studies are necessary to confirm the safety profile and to ensure that the beneficial effects are independent of other clinical interventions.

1Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.

2Institute for Global Health and Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA.

3Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.

Supported, in part, by the NIH Clinical and Translational Science Award NIH/NCRR CTSA 1UL1 RR025744 for the Stanford Center for Clinical and Translational Education and Research (Spectrum) and by the Lucile Packard Foundation for Children’s Health.

Dr. Axelrod received grant support from the NIH Clinical and Translational Science Award for the Stanford Center for Clinical and Translational Education and Research and the Lucile Packard Foundation for Children's Health and consulted for Astellas Pharmaceuticals. Dr. Anglemyer received payment from Stanford University for statistical and methodologic assistance for this project and worked with Stanford for a number of manuscripts as an independent epidemiologist. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: daxelrod@stanford.edu

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies