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A Case Control Study Of Acute Renal Failure In Cystic Fibrosis Patients In The United Kingdom
  1. Alan Smyth (alan.smyth{at}
  1. University of Nottingham, United Kingdom
    1. Sarah Lewis (sarah.lewis{at}
    1. University of Nottingham, United Kingdom
      1. Carol Bertenshaw (carol.bertenshaw{at}
      1. University of Nottingham, United Kingdom
        1. Imti Choonara (imti.choonara{at}
        1. University of Nottingham, United Kingdom
          1. Jean McGaw (jean.mcgaw{at}
          1. University of Nottingham, United Kingdom
            1. Alan Watson (alan.watson{at}
            1. Nottingham University Hospitals NHS Trust, United Kingdom


              Background: There has been a recent increase in the number of reported cases of acute renal failure (ARF) in cystic fibrosis (CF). We conducted a case control study to determine the factors which are associated with an increased risk of ARF.

              Methods: Our initial survey confirmed 24 cases of ARF, in CF patients from 20 UK CF Centres, presenting between 1997 & 2004. Using the UK CF database, we identified sex and age matched controls. Informed consent was sought from the control patients / parents for access to the case notes. Analysis of risk factors was by conditional logistic regression and Mantel Haenzsel analysis, using Stata (version 9).

              Results: In the group of patients with ARF, 21/24 had received an aminoglycoside at the time of their episode of ARF or in the preceding week, compared with only 3/42 controls for the same time period (OR 81.8, 95% CI 4.7 to 1427, p<0.001). In the year prior to the episode of ARF, significantly more cases than controls received gentamicin (19/24 cases vs. 1/42 controls, p<0.001). The numbers receiving tobramycin were similar (9/24 cases vs. 15/42 controls, p=0.9). A known risk factor for renal impairment (prior renal disease, acute dehydration or long term nephrotoxic drug treatment) was present in 18/24 cases & 7/42 controls (OR 24.0, 95% CI 3.1 to 186.6, p = 0.002).

              Conclusions: In CF patients, the use of an intravenous aminoglycoside is a risk factor for ARF and gentamicin is more nephrotoxic than tobramycin. The majority of patients who develop ARF have a risk factor which necessitates withholding aminoglycosides or more closely monitoring their use.

              • acute renal failure
              • aminoglycosides
              • cystic fibrosis
              • gentamicin

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