A study done at Vanderbilt and published in JAMA Pediatrics found that children who had heart surgery were less likely to develop kidney injury if they were treated with acetaminophen in the first 48 hours following surgery. According to Sara Van Driest, MD, PhD, assistant professor of Medicine and Pediatrics, one of the study’s authors, this is a very important finding because acute kidney injury is a common problem after this kind of surgery and there used to be no medication to treat or prevent it.
The retrospective observational study involved 999 pediatric surgery patients given acetaminophen at Vanderbilt and Duke University and had lower rates of acute kidney injury. “We found that the more acetaminophen that they got, the less likely they were to have acute kidney injury,” said Van Driest. “Even after we took measures to adjust for how sick the patients were, how long their cardiac surgery was, and how many risk factors they had for acute kidney injury, the protective effect of acetaminophen remained.”
So far, about 50% of the children who had cardiac surgery, at least 25% of those who needed intensive care and at least 5% of all the children admitted to the pediatric unit developed acute kidney injury. “This is important because those patients who have acute kidney injury are known to have increases in mortality during that hospital stay, and in morbidity, meaning that they have worse kidney function in the months and years after,” Van Driest said. “They also have longer stays in the hospital, which is hard on patients and families.”
For many years scientists at Vanderbilt were trying to understand the pathways that acetaminophen targets. Previous research provided a hypothesis that scientists could test – that acetaminophen can prevent acute kidney injury. As a result, the scientists found that acetaminophen can prevent damage that is caused by free hemoglobin, one of the byproducts of the breakdown of red blood cells during bypass surgery.
Following this finding, the scientists believe a randomized trial is needed to validate the findings. Even more randomized trials might follow in other conditions that also cause the release of free hemoglobin, such as sepsis and sickle cell disease.
Collaborators in the study included the departments of Medicine, Pediatrics, Biomedical Informatics, Biostatistics, Pharmacology, and Pathology, Microbiology and Immunology at Vanderbilt. From Duke University the participants were the Department of Pediatrics and the Cardiovascular Perfusion Technology Program.
The study showcases several strengths of Vanderbilt such as their ability to extract date out of electronic records, the ability of various departments to collaborate towards one goal and the important role played by Biostatistics in developing a robust methodology that could be reproduced at Duke University.