720-777-0123
Key takeaways
-
Researchers found no significant difference in acute kidney injury (AKI) incidence between patients who received non-steroidal anti-inflammatory drugs (NSAIDs) after lower urinary tract reconstruction and those who did not.
-
This is the first known study to evaluate if NSAIDS increase the AKIs for this population and can be used as a safe, non-opioid alternative for pain management.
-
AKI risk is likely related to an underlying disease, longer surgeries and variations in fluid intake.
Research study background
Pain management after pediatric lower urinary tract reconstruction requires careful consideration which includes an emphasis on using non-opioid alternatives like non-steroidal anti-inflammatory drugs (NSAIDs). However, concerns about the risk of developing acute kidney injury (AKI) or chronic kidney disease (CKD) persist.
To assess NSAID safety in this context, researchers in the Department of Pediatric Urology at Children’s Hospital Colorado conducted a retrospective review of patients aged 2 to 18 years old who underwent lower urinary tract reconstruction between 2009 and 2021. Surgeries included bladder augmentation, catheterizable channel creation, antegrade continence enema channel creation, bladder neck reconstruction and bladder neck sling or closure. Patients with less than 48 hours of postoperative urine output recordings, prior kidney transplants, or Stage 4 or 5 CKD were excluded.
AKI was defined using Kidney Disease: Improving Global Outcomes criteria: serum creatinine increases ≥0.3 mg/dL within 48 hours or ≥1.5 times baseline, or urine output <0.5 mL/kg/hour for six hours.
Propensity matching on 11 characteristics identified 166 patients in the NSAIDs group and 41 in the no-NSAIDs group. Results showed no significant difference in the incidence of AKI (17.1% no NSAIDs vs. 16.3% NSAIDs) or time to low urine output between the groups. In the overall population not stratified by NSAID use, AKI incidence did not differ between patients with CKD (16.7%) and those without (17.9%).
“Our findings dispel the idea that clinicians should not or cannot safely give NSAIDs to patients undergoing lower urinary tract reconstruction. While acute kidney injury remains a risk after these surgeries, it is mostly indicated by low urine output and appears to be associated with underlying disease, longer length of operations and variations in fluid intake.”
- KYLE ROVE, MD
Relevance to practice
Study authors noted the risk of acute kidney injury is not increased by using NSAIDs and can be used safely as part of an enhanced recovery after surgery protocol, which also includes maintaining a regular diet up to surgery, avoiding mechanical bowel preparation, consuming a preoperative carbohydrate drink, an early return to diet and maintaining euvolemia during surgery.
Additionally, the urine output algorithm developed for this study offers a potential tool for real-time clinical decision support post-surgery that can be integrated into electronic medical record systems.
Featured researchers
Kyle Rove, MD
Pediatric urologist
Department of Pediatric Urology
Children's Hospital Colorado
Associate professor
Surgery-Urology
University of Colorado School of Medicine
Duncan Wilcox, MD
Surgeon in Chief
Pediatric Urology
Children's Hospital Colorado
Professor
Surgery-Urology
University of Colorado School of Medicine
Vijaya Vemulakonda, MD
Pediatric urologist
Department of Pediatric Urology
Children's Hospital Colorado
Professor
Surgery-Urology
University of Colorado School of Medicine
Dan Wood, PhD, MB.BS, FRCS (Urol)
Associate Vice Chair of Transitional Care and Chair of Adult Congenital Surgery
Department of Pediatric Urology
Children’s Hospital Colorado
Professor
Surgery-Urology
University of Colorado School of Medicine
Eliza Blanchette, MD
Pediatric nephrologist
Department of Pediatric Nephrology
Children's Hospital Colorado
Assistant professor
Pediatrics-Nephrology
University of Colorado School of Medicine
