There are two types of kidney damage - chronic (long-term) and acute (meaning there is a sudden decrease in kidney functioning). We know that having acute kidney damage increases the chances of developing long-term kidney damage. In people with kidney damage, it is important to avoid prescribing medications that are potentially toxic to their kidneys (known as 'nephrotoxic' medications). Unfortunately, in adults, studies show that many people with kidney damage receive nephrotoxic medications. Like adults, children with existing kidney disease should not be prescribed these medications unless absolutely necessary. Unfortunately, no one has evaluated whether this is currently the case in children. Our suspicion is that these at-risk children are being prescribed nephrotoxic medications as much as children with healthy kidneys. We therefore propose to study if nephrotoxic medications are being prescribed to children with acute or chronic kidney damage, compared to children with normal kidneys. Ideally, children with kidney damage will be prescribed fewer of these medications. This research will be important. If we find that nephrotoxic medications are being prescribed to children with kidney disease, this will represent a huge opportunity to create programs to inform doctors, patients and pharmacists about this reality to help change it.
This is a cohort study of children 18 years of age or under, registered to the Clinical Practice Research Datalink (CPRD) between 1997 and 2016. There are two populations of interest: children with a history of hospital-associated acute kidney injury (AKI) and children with a diagnosis of chronic kidney disease (CKD). The objective of this study is to describe and compare primary care prescriptions of nephrotoxic medications (NTM) in children with versus without a history of AKI and in children with versus without a diagnosis of CKD. Unexposed children (without AKI or CKD) will be matched 4:1 on age, sex, CPRD practice and date of diagnosis or date of hospital discharge if the diagnosis was made during a hospitalization. We will look at the overall prevalence of NTM exposure and the number of different NTM prescribed within 1 year of AKI and within 5 years of CKD diagnosis respectively. Characteristics of exposed and unexposed children will be summarized and controlled for in multivariate analyses if they differ. Prevalence of 1 or more NTM prescriptions in incident AKI and CKD patients (95% CI) will be compared to matched, unexposed comparators using conditional logistic regression. The number of different NTM prescribed will be compared using Poisson regression.
Prescription of nephrotoxic medications; Intensity of prescription of nephrotoxic medications; Number of hospitalisations.
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Robert Platt - Corresponding Applicant - McGill University
Claire Lefebvre - Collaborator - McGill University
Ke Meng - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Kristian Filion - Collaborator - McGill University
Michele Zappitelli - Collaborator - McGill University
pauline reynier - Collaborator - Sir Mortimer B Davis Jewish General Hospital
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation