Nephrotoxin Induced Acute Kidney Injury (NAKI)

How common is NAKI?

• Over 80% of hospitalized pediatric patients are exposed to at least one nephrotoxic medication (NTMx).
• NTMx exposure is one of the most common causes of Acute Kidney Injury (AKI) in non-critically ill hospitalized children.
• Children with high NTMx exposure (IV Aminoglycosides or vancomycin for >3 days OR >3 NTMx in a single day) develop Acute Kidney Injury (AKI) 25% of the time.

Which Patients Are at Risk?

Patients who are at risk for NAKI have received any of the following:

• ≥3 NTMx in a single day
• ≥3 days of an IV aminoglycoside or vancomycin
• 2 NTMx in a single day + exposure to iodinated contrast within the preceding 7 days

View the full list of nephrotoxic medications.

How is Golisano Children’s Hospital Preventing NAKI?

• GCH is participating in a national Quality Initiative Project to prevent NAKI by identifying patients at risk and monitoring daily creatinine in those patients.

How Do We Monitor for NAKI?

• For at risk patients, pharmacists will contact covering provider and recommend serum creatinine monitoring during the exposure period and for 48 hours after the exposure stops.
• If AKI is identified, serum creatinine should be monitored daily until back to baseline for 48 hours.

What Do YOU as Prescribers Have To Do?

• Consider ordering the daily serum creatinine when recommended by pharmacy.
• Consider withdrawing nephrotoxic medications based on recommendations of pharmacy.
• Discuss possible nephrotoxicity of medication regimen on daily rounds.

Do We Have Evidence That This Initiative Works?

• After 1 year, Cincinnati Children’s observed a 42% reduction in days with NAKI per 100 days of NTMx exposure.
• This most likely resulted from earlier AKI detection and withdrawal of NTMx.