Xanthine Derivatives for Kidney Protection in the Critically Ill Pediatric Population: A Systematic Review

Abstract

Different types of diuretics have been used to minimize fluid overload after resuscitation. This meta-analysis determined the effects of xanthine derivatives on creatinine, creatinine clearance, and urine output. Studies included data from pediatric patients, whoused theophylline or aminophylline, and included pre- and postxanthine data for at least one of the outcomes of interest. A total of 13 studies with 198 patients were included in the pooled analyses. The study recorded data prior, and a mean of 36 hours after xanthine administration. This meta-analysis demonstrates that xanthine derivatives in critically ill children, using a dose of approximately5 mg/kg, lead to a statistically significant increase in creatinine clearance and urine output without significantly altering serum creatinine. Xanthine derivatives may be beneficial for fluid management in critically ill children. Further studies are warranted assessing the association with additional clinical outcomes.

Keywords

pediatric patients - critically ill children - xanthines

• References

• 1 da Silva PS, de Aguiar VE, Fonseca MC. Additive diuretic response of concurrent aminophylline and furosemide in children: a case series and a brief literature review. J Anesth 2012; 26 (01) 118-123
• 2 Axelrod DM, Anglemyer AT, Sherman-Levine SF. , et al. Initial experience using aminophylline to improve renal dysfunction in the pediatric cardiovascular ICU. Pediatr Crit Care Med 2014; 15 (01) 21-27
• 3 Huet F, Semama D, Grimaldi M, Guignard JP, Gouyon JB. Effects of theophylline on renal insufficiency in neonates with respiratory distress syndrome. Intensive Care Med 1995; 21 (06) 511-514
• 4 Jenik AG, Ceriani Cernadas JM, Gorenstein A. , et al. A randomized, double-blind, placebo-controlled trial of the effects of prophylactic theophylline on renal function in term neonates with perinatal asphyxia. Pediatrics 2000; 105 (04) E45
• 5 McLaughlin GE, Land MP, Rossique-Gonzalez M. Effect of aminophylline on urine flow in children with tacrolimus-induced renal insufficiency. Transplant Proc 2000; 32 (04) 817-820
• 6 Pretzlaff RK, Vardis RJ, Pollack MM. Aminophylline in the treatment of fluid overload. Crit Care Med 1999; 27 (12) 2782-2785
• 7 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
• 8 Lochan SR, Adeniyi-Jones S, Assadi FK, Frey BM, Marcus S, Baumgart S. Coadministration of theophylline enhances diuretic response to furosemide in infants during extracorporeal membrane oxygenation: a randomized controlled pilot study. J Pediatr 1998; 133 (01) 86-89
• 9 Bakr AF. Prophylactic theophylline to prevent renal dysfunction in newborns exposed to perinatal asphyxia—a study in a developing country. Pediatr Nephrol 2005; 20 (09) 1249-1252
• 10 Bhat MA, Shah ZA, Makhdoomi MS, Mufti MH. Theophylline for renal function in term neonates with perinatal asphyxia: a randomized, placebo-controlled trial. J Pediatr 2006; 149 (02) 180-184
• 11 Mazkereth R, Laufer J, Jordan S, Pomerance JJ, Boichis H, Reichman B. Effects of theophylline on renal function in premature infants. Am J Perinatol 1997; 14 (01) 45-49
• 12 Cattarelli D, Spandrio M, Gasparoni A, Bottino R, Offer C, Chirico G. A randomised, double blind, placebo controlled trial of the effect of theophylline in prevention of vasomotor nephropathy in very preterm neonates with respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 2006; 91 (02) F80-F84
• 13 Tamburro RF, Thomas NJ, Ceneviva GD, Dettorre MD, Brummel GL, Lucking SE. A prospective assessment of the effect of aminophylline therapy on urine output and inflammation in critically ill children. Front Pediatr 2014; 2: 59
• 14 Bell M, Jackson E, Mi Z, McCombs J, Carcillo J. Low-dose theophylline increases urine output in diuretic-dependent critically ill children. Intensive Care Med 1998; 24 (10) 1099-1105
• 15 McLaughlin GE, Abitbol CL. Reversal of oliguric tacrolimus nephrotoxicity in children. Nephrol Dial Transplant 2005; 20 (07) 1471-1475
• 16 Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016; 17 (01) 109
• 17 Goldstein S, Bagshaw S, Cecconi M. , et al; ADQI XII Investigators Group. Pharmacological management of fluid overload. Br J Anaesth 2014; 113 (05) 756-763