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Kidney Week

Abstract: PO0182

Identifying Factors Associated with Clinically Adjudicated Drug-Induced AKI in Children

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention


  • Yousif, Zaid, University of California San Diego, La Jolla, California, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  • Askenazi, David J., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Brophy, Patrick D., University of Rochester Medical Center, Rochester, New York, United States
  • Ha, Il-Soo, Seoul National University Children's Hospital, Seoul, Korea (the Republic of)
  • Jha, Vivekanand, The George Institute for Global Health UK, Oxford, Oxfordshire, United Kingdom
  • Benador, Nadine M., University of California San Diego, La Jolla, California, United States
  • Riley, Alyssa A., The University of Texas at Austin, Austin, Texas, United States
  • Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
  • Yang, Li, Peking University First Hospital Department of Nephrology, Beijing, Beijing, China
  • Ng, Kar Hui, National University of Singapore, Singapore, Singapore
  • Vaingankar, Sucheta M., University of California San Diego, La Jolla, California, United States
  • Mehta, Ravindra L., University of California San Diego, La Jolla, California, United States
  • Awdishu, Linda, University of California San Diego, La Jolla, California, United States

Group or Team Name

  • DIRECT Investigators

Drug-induced acute kidney injury (DI-AKI) affects up to 33% of hospitalized children. Clinical adjudication of DI-AKI is challenging since AKI is multifactorial. We report clinical variables that influence ascertainment of DI-AKI cases and inter-rater reliability (IRR) of existing causality assessment tools (CAT) for adverse drug events.


We analyzed data from the DIRECT study, an international, multi-center, observational cohort study of clinically adjudicated pediatric cases of AKI stage 2 associated with nephrotoxic medication (NTMx) exposure. Each case was adjudicated by two pediatric nephrologists using CAT. A third adjudicator acted as the tiebreaker. IRR was calculated using Krippendorff’s alpha. We developed variables to capture exposure to NTMx and serum creatinine trends. We constructed a multivariable logistic regression model with clinically adjudicated DI-AKI as the outcome and clinical variables as predictors.


115 (86.5%) out of 133 children were adjudicated as DI-AKI. The mean age was 12.2 ± 4.5 years, and the most frequent NTMx: vancomycin (43.6%), piperacillin/tazobactam (32.3%), and non-steroidal anti-inflammatory drugs (18.8%). AKI risk factors were comparable between clinically adjudicated DI-AKI and Not DI-AKI groups. Past medical history of malignancy, increased vascular capacity (i.e., sepsis or hypotension), and severe AKI treated with dialysis made DI-AKI adjudication less likely. Longer duration from the start of drug exposure to AKI onset made DI-AKI adjudication more likely. The IRR of the Liverpool (ka = 0.35) and the Naranjo (ka = 0.31) CAT were poor.


DI-AKI adjudication is a complex and multifactorial process. Current CAT appear to be unreliable. Development of CAT specific to DI-AKI is needed to perform robust outcomes research.


  • Other NIH Support