The risk of development of acute kidney injury in full-term infants with administration of methylxanthines

Abstract

Exploring new possibilities for the\xa0use of methylxanthines to prevent the\xa0development of acute kidney injury (AKI) in full-term infants with perinatal asphyxia.\nAim: to evaluate the\xa0efficacy and safety of methylxanthines in full-term infants for the\xa0prevention and conservative treatment of acute kidney injury.\nMaterials and methods. To test the\xa0effectiveness of the\xa0proposed method of AKI treatment, 38 infants were chosen and divided into 2 groups by random selection. Nursing and intensive care were according to current legislation (Order of the\xa0Ministry of Health of Ukraine No. 225 of March 28, 2014). The main group (n\u2007=\u200720) received therapy with caffeine citrate, the\xa0comparison group (n\u2007=\u200718)\u2007– theophylline. Both of these drugs were used to prevent the\xa0development of acute kidney injury\u2007– stage II and III according to KDIGO.\nResults. A significant difference in serum creatinine was found in the\xa0main group - the\xa0level of serum creatinine was higher than in the\xa0comparison group, but did not exceed the\xa0physiological norm. GFR on the\xa03rd day of life was higher with administration of theophylline, but in the\xa0group of caffeine did not exceed the\xa0reference values of the\xa0norm. No differences between urea levels and diuresis rates were found in the\xa0groups. The initial results indicate the\xa0lack of statistical significance when using various drugs of the\xa0methylxanthine group, namely theophylline and caffeine citrate. This is explained by the\xa0fact that in the\xa0main group 65.00\u2007% (n\u2007=\u200713) of patients had AKI stage 0 according to KDIGO, and 35.00\u2007% (n\u2007=\u20077) had stage I. In the\xa0comparison group, 55.56\u2007% (n\xa0=\xa010) and 44.44\u2007% (n\u2007=\u20078), respectively. Stages II and III in both groups of the\xa0study did not develop, the\xa0obtained data are equivalent\u2007– U\u2007=\u2007163,00; P\u2007=\u20070,6296. However, the\xa0use of caffeine citrate may become a priority due to a better safety profile compared to theophylline. Caffeine is less likely to cause adverse effects in the\xa0form of non-pathological bile vomiting and has significantly lower relative risk of non-pathological bile vomiting in infants (RR 0.26 (95\u2007% CI 0.10; 0.66)).\nConclusions. Conservative methylxanthine therapy in full-term infants with perinatal asphyxia prevents the\xa0development of stages II and III of AKI according to KDIGO. However, it is necessary to continue the\xa0collection of material to increase the\xa0statistical significance, as well as to study the\xa0early and long-term consequences of this therapy.