Nephrotoxicity associated with aminoglycoside therapy in paediatrics: experiences from a leading referral hospital in Kenya

TL;DR

This study found that aminoglycoside antibiotics caused kidney damage in 10% of children in Kenya, especially in low-birth-weight neonates with sepsis.

Contribution

The study identifies neonates with sepsis and low birth weight as high-risk groups for aminoglycoside-induced nephrotoxicity in a Kenyan hospital setting.

Findings

Nephrotoxicity occurred in 10.3% of children receiving aminoglycosides.

Neonates with low birth weight and sepsis had a significantly higher risk of kidney injury.

65% of children with nephrotoxicity were switched to alternative antibiotics.

Abstract

This study assessed the prevalence and risk factors of nephrotoxicity in paediatric patients receiving aminoglycoside therapy at the Kenyatta National Hospital (KNH) in Kenya.

Between July and September 2018, a prospective cohort study involving children receiving aminoglycoside treatment was carried out at KNH. Before beginning and after finishing the aminoglycoside therapy, the levels of serum creatinine were assessed. Descriptive statistics were used to describe the patients’ clinical and sociodemographic features. Associations between nephrotoxicity and maternal and paediatric variables were assessed using multivariable logistic regression.

The final analysis comprised 195 children and the prevalence of nephrotoxicity was 10.3%. Neonates made up 28.7% (58/195) of the total and their risk of developing nephrotoxicity was 3.54 (95% CI 1.6–8.21) times higher than that of other children (P = 0.003). Neonates with low birth weight were 4.73 (95% CI: 1.8–12.5) times more likely to develop nephrotoxicity than those whose birth weight was >2500 g (P = 0.002). Neonatal patients with sepsis had a 4.91 (95% CI: 2.07–11.62) times greater association with acute kidney injury than neonates receiving treatment for other illnesses (P = 0.001). Sixty-five percent (13/20) of children who developed nephrotoxicity were switched to cephalosporins.

Aminoglycosides were more nephrotoxic to asphyxiated, low-birth-weight neonates with sepsis. Routine monitoring of kidney function should be done within 72 h of starting aminoglycoside treatment in all neonates.