Article Text

other Versions

PDF

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

              Abstract

              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

              Statistics from Altmetric.com

              Request permissions

              If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

              Linked Articles