|CBC News Health|
|Counsel and Heal|
The publicity department of Indiana University must be quite pleased with themselves with the wide coverage this study has produced but behind the curtain we really have very little data. The study was published in J Peds (Abstract | PDF). The authors did a retrospective chart review of 11.5 years of inpatient records from Riley Children’s Hospital in Indianapolis. They found 1,015 patients with acute renal failure by screening ICD-9 codes. This is a shockingly low frequency to me. Eighty-eight cases a year in a major children’s teaching hospital makes me think theire screening methodology was quite insensitive.
Although volume depletion is an independent risk factor for AKI, patients with a history of volume depletion in the absence of sepsis or multiorgan failure were not excluded from classification as having NSAID-associated AKI, as it is likely that volume depletion increases the risk of NSAID use leading to AKI.
Our study is the largest series to date demonstrating that NSAIDs are a common cause of AKI in children.
However, it should be noted that in our population, many patients who were deemed to have developed multifactorial AKI (and thus were not included in the case definition of NSAID-associated AKI) did have NSAID exposure as one of their multiple risk factors for AKI.
This feels disingenuous. If you create the case definition, don’t try to spin your results by essentially saying, if we had a different, less specific, case definition we would have found more cases.
Of note: the authors found that 44% of the cases were above the 95% for height:weight or BMI. The authors tried to see if this was due to NSAID overdose because of parents dosing kids by actual rather than ideal weight. This was not the case. However this is consistent with the recent results about adiposity being related to AKI in trauma patients. Obesity, an independent risk factor for AKI. Neat.