G334(P) Risk factors associated with ibuprofen induced acute kidney injury in the paediatric population: a systematic review

• Published in: Archives of disease in childhood Vol. 105; no. Suppl 1; p. A121
• Main Authors: Cousins, S, Oni, L, McWilliam, SJ
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01-10-2020
• Subjects: Analgesics; Case studies; Children; Clinical trials; Creatinine; Dehydration; Fever; Gastroenteritis; Ibuprofen; Kidneys; Nonsteroidal anti-inflammatory drugs; Observational studies; Paracetamol; Pediatrics; Population; Renal function; Risk factors; Systematic review; Urea
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-rcpch.288

AimsIbuprofen is commonly used in children. However, its use can be associated with renal adverse effects. This systematic review aimed to determine risk factors associated with ibuprofen induced acute kidney injury (AKI) in the paediatric population.MethodsA systematic review was performed in January 2019 using PubMed and Web of Science. Eligible clinical trials and observational studies included ibuprofen as an intervention in children (0 to <18 years) and reported risk factors associated with AKI.ResultsOf 333 publications identified, four were selected for inclusion. In a prospective case-control study of 105 children with dehydration secondary to acute gastroenteritis 44% presented with AKI. Of those who received ibuprofen prior to admission, 54% had AKI. Ibuprofen was an independent risk factor for AKI development (p<0.001, odds ratio 2.47, 95% CI 1.78–3.42). A randomised controlled trial (n=288) compared renal outcomes in children with fever who received ibuprofen or paracetamol. Neither blood urea nitrogen (BUN) or creatinine levels varied significantly by treatment group. However, when comparing dehydrated children to the overall population there was a greater percentage of dehydrated patients with BUN >6.4 mmol/L (14% v 8.1%) and creatinine levels >62 µmol/L (14% v 9.5%). One retrospective case-control study (47803 adverse event reports) found a reporting odds ratio (ROR) for AKI in children receiving Ibuprofen of 2.14 (95% CI: 1.59–2.88). Concomitant use of paracetamol with ibuprofen increased the ROR for AKI to 4.01 (95% CI 2.96–5.43). One retrospective cohort study (2 partially overlapping cohorts: n=31561 and n=167523) compared the risk of renal adverse events with ibuprofen use in children aged <6 months versus those aged 6–12 months. There was no difference between the groups after adjusting for prior renal impairment (adjusted RR 0.42, 95% CI 0.17–1.08).ConclusionThe findings of this systematic review indicate dehydration and concomitant use with paracetamol are potential risk factors for ibuprofen induced AKI. However, there was a limited number of studies related to the research question and the results are likely to be influenced by confounding factors. Further studies are required to determine the precise risk factors associated with ibuprofen induced AKI in the paediatric population.