1
|
Van Siang Lian Mang P, Hui JC, Tan RSJ, Hasan MS, Choo YM, Abosamak MF, Ng KT. The diuretic effect of adding aminophylline or theophylline to furosemide in pediatric populations: a systematic review. Eur J Pediatr 2023; 182:1-8. [PMID: 36251063 DOI: 10.1007/s00431-022-04655-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 01/12/2023]
Abstract
UNLABELLED The diuretic effect of the combined furosemide and aminophylline/theophylline among pediatric patients remains unclear. The primary aim of this systematic review was to examine the clinical diuretic effects (urine output and fluid balance) of co-administration of furosemide and aminophylline/theophylline as compared to furosemide alone in pediatric population. Ovid MEDLINE, CENTRAL, and EMBASE were searched from its inception until March 2022 for observational studies and randomized controlled trials (RCTs) comparing the administration of furosemide versus furosemide and aminophylline/theophylline in pediatric population. Case reports, case series, commentaries, letters to editors, systematic reviews, and meta-analyses were excluded. Five articles with a total sample population of 187 patients were included in this systematic review. As compared to the furosemide alone, our pooled data demonstrated that co-administration of furosemide and aminophylline/theophylline was associated with higher urine output (mean difference: 2.91 [90% CI 1.54 to 4.27], p < 0.0001, I2 = 90%) and a more negative fluid balance (mean difference - 28.27 [95% CI: - 46.21 to - 10.33], p = 0.002, I2 = 56%) than those who received furosemide alone. CONCLUSION This is the first paper summarizing the evidence of combined use of furosemide with aminophylline/theophylline in pediatric population. Our systematic review demonstrated that the co-administration of furosemide and aminophylline/theophylline could potentially yield better diuretic effects of urine output and negative fluid balance than furosemide alone in pediatric patients with fluid overload. Given the substantial degree of heterogeneity and low level of evidence, future adequately powered trials are warranted to provide evidence regarding the combined use of aminophylline/theophylline and furosemide as diuretic in the pediatric population. WHAT IS KNOWN • Fluid overload is associated with poor prognosis for children in the intensive care unit. • The ineffective result of furosemide alone, even at high dose, as diuretic agent for children with diuretic resistant fluid overload in the intensive care unit. WHAT IS NEW • This is the first systematic review that compares furosemide alone and co-administration of furosemide and aminophylline/theophylline. • This paper showed potential benefit of co-administration of furosemide and aminophylline/theophylline promoting urine output and negative fluid balance compared to furosemide alone.
Collapse
Affiliation(s)
| | | | | | - M Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yao Mun Choo
- Department of Paediatrics, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohammed F Abosamak
- Department of Anaesthesia and Intensive Care Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ka Ting Ng
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| |
Collapse
|
2
|
Zhang R, Liu H, Dai D, Ding X, Wang D, Wang Y, Shi X, Zhang S, Duan X, Wang H, Luo Y, Liu S, Han B, Zhang X, Fang Y, Yang J, Xu W, Sun T. Adjunctive sepsis therapy with aminophylline (STAP): a randomized controlled trial. Chin Med J (Engl) 2022; 135:2843-2850. [PMID: 36728571 PMCID: PMC9944697 DOI: 10.1097/cm9.0000000000002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sepsis is a serious disease caused by infection. Aminophylline has anti-asthma and anti-inflammatory effects. We aimed to explore the safety and effect of aminophylline in sepsis. METHODS We conducted a clinical randomized controlled trial involving 100 patients diagnosed with sepsis within 48 h after intensive care unit (ICU) admission in two sites. All patients were randomized in a 1:1 ratio to receive standard therapy with or without aminophylline. The primary clinical outcome was all-cause mortality at 28 days. RESULTS From September 27, 2018 to February 12, 2020, we screened 277 septic patients and eventually enrolled 100 patients, with 50 assigned to the aminophylline group and 50 to the usual-care group. At 28 days, 7 of 50 patients (14.0%) in the aminophylline group had died, compared with 16 of 50 (32.0%) in the usual-care group ( P = 0.032). Cox regression showed that the aminophylline group had a lower hazard of death (hazard ratio = 0.312, 95% confidence interval: 0.129-0.753). Compared with the usual-care group, patients in the aminophylline group had a longer survival time ( P = 0.039 by the log-rank test). The effects of aminophylline on vasopressor dose, oxygenation index, and sequential organ failure assessment score were time-dependent with treatment. There were no significant differences in total hospitalization days, ICU hospitalization days, and rates of serious adverse events (all P > 0.05). No adverse events were observed in the trial. CONCLUSIONS Aminophylline as an adjunct therapy could significantly reduce the risk of death and prolong the survival time of patients with sepsis. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR1800019173.
Collapse
Affiliation(s)
- Ruifang Zhang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Huan Liu
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Dongmei Dai
- Department of Intensive Care Unit, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Xianfei Ding
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Dong Wang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Yan Wang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Xuexiu Shi
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Shuguang Zhang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Xiaoguang Duan
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Haixu Wang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Yonggang Luo
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Shaohua Liu
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Bing Han
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Xiaojuan Zhang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Yu Fang
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| | - Jing Yang
- Precision Medicine Monitoring Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Wangbin Xu
- Department of Intensive Care Unit, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Tongwen Sun
- General ICU, The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou, Henan 450052, China
| |
Collapse
|
3
|
Yavuz Y, Isildak FU. Effect of intraoperative theophylline use on acute kidney injury in paediatric cardiac surgery. Cardiol Young 2022; 33:1-9. [PMID: 35105399 DOI: 10.1017/s1047951122000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study aimed to examine the effects of theophylline use in preventing renal dysfunction in patients undergoing CHD surgery. METHODS A total of 94 patients aged 1-60 months were included in the study. Patients in the theophylline group were enrolled according to a pre-defined protocol for treatment administration, while controls were selected retrospectively from patients without theophylline treatment during the same period - who were matched according to critical baseline characteristics. RESULTS The incidence of acute kidney injury was similar between the two groups (p = 1.000). Higher urinary output and lower fluid balance were found intraoperatively and also postoperatively in the theophylline group (all, p < 0.050). Postoperative decrease in urinary output and estimated glomerular filtration rate were higher in the theophylline group (p < 0.050). Lower postoperative urea and creatinine levels were shown in theophylline recipients (p < 0.050). Urea levels increased significantly in the non-theophylline group during surgery (p < 0.001), and no significant change was observed in theophylline group (p = 0.136). Postoperative increase in creatinine and lactate levels was demonstrated in theophylline group (p < 0.050), and lactate levels were higher in the non-theophylline group during and after cardiopulmonary bypass (p = 0.010). Multiple linear regression analysis revealed less reduction in estimated glomerular filtration rate with higher age and in the presence of theophylline use (p < 0.050). CONCLUSION Although we demonstrated a similar incidence of acute kidney injury in the both groups, we revealed an important decrease in serum creatinine, urea and lactate levels, accompanied by improved estimated glomerular filtration rate, increased urine output and decreased fluid overload, with theophylline treatment, suggesting that renal functions significantly improved with the use of theophylline.
Collapse
Affiliation(s)
- Yasemin Yavuz
- Department of Anesthesia and Reanimation, Istanbul Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| | - Fatma Ukil Isildak
- Department of Anesthesia and Reanimation, Istanbul Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Peri-transplant aminophylline in pediatric kidney transplant recipients of donation after brain death: a double-blinded placebo-controlled randomized clinical trial. Pediatr Nephrol 2020; 35:1729-1736. [PMID: 32418145 DOI: 10.1007/s00467-020-04561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND During kidney transplantation, the transplanted kidney undergoes ischemia reperfusion injury, with adenosine being a major mediator. This study aimed to assess whether aminophylline, an adenosine receptor antagonist, improves early graft function and reduces incidence of delayed graft function (DGF) and slow graft function (SGF). METHODS Single center, double-blinded, placebo-controlled randomized clinical trial. Pediatric patients admitted for renal transplantation from donation after brain death donors were randomized into a treatment arm receiving aminophylline and a placebo arm receiving normal saline infusions. Primary outcome was estimated glomerular filtration rate (eGFR) at 5 days post-transplant. Secondary outcomes were rates of DGF/SGF and urinary neutrophil gelatinase-associated lipocalin (NGAL) levels. RESULTS Twenty-three patients were randomized to aminophylline and 27 to placebo. There was no difference in day 5 eGFR, rate of DGF/SGF, or urine NGAL/Creatinine level between aminophylline vs. placebo arm (eGFR 67.39 ± 38.9 ml/min/1.73m2 vs. 80.48 ± 52.1 ml/min/1.73m2p = 0.32; DGF/SGF 5/23 (21.7%) vs. 3/27 (11.1%) p = 0.31; urine NGAL/creatinine 300.5 ng/mg IQR 105.5-1464.5 ng/mg vs. 425.4 ng/mg IQR 140.3-1126.2 ng/mg, p = 0.95; respectively). At 12 months, there was 100% patient survival and 98% graft survival. eGFR at 12 months was similar between the two arms. CONCLUSIONS There was no benefit in peri-transplant aminophylline administration. Our results are limited by small sample size, since sample calculations were based on primary outcome of day 5 eGFR and low rate of DGF/SGF, which may have precluded us from demonstrating efficacy. Further clinical studies are necessary to determine any benefit of aminophylline in kidney transplant recipients, particularly from high-risk donors.
Collapse
|
5
|
Alsaadoun S, Rustom F, Hassan HA, Alkhurais H, Aloufi M, Alzahrani S, Bakhsh S, Dalbhi SA. Aminophylline for improving acute kidney injury in pediatric patients: A systematic review and meta-analysis. Int J Health Sci (Qassim) 2020; 14:44-51. [PMID: 33192231 PMCID: PMC7644458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Acute kidney injury (AKI) is a major cause of morbidity and mortality. Whether aminophylline administration can prevent or treat AKI among pediatric patients are not clear. This meta-analysis aimed to assess the efficacy and effectiveness of aminophylline for pediatric AKI. METHODS We carried out a systematic search of six databases: PubMed, EMBASE/Excerpta Medica, Scopus, Cochrane library, and Google Scholar from January 1995 up till May 2019. Summary measures of risk ratios and standard mean difference were calculated using the random effects model. RESULTS We identified seven papers containing data on aminophylline use in children with AKI. Meta-analysis of single-arm studies indicated no statistically significant difference in mean rate of serum creatinine clearance (-0.39 [-0.80-1.58], P = 0.52), mean urine output (1.99 [-1.43-5.42]; P = 0.25), or mean blood urea nitrogen levels (0.83 [-1.86-3.03], P = 0.54) before and after aminophylline administration. However, among double-arm studies, aminophylline administration in the intervention arm significantly reduced the serum creatinine level as compared to control arm (mean diff = -34 [-55.18--12.83]; P = 0.002). Mean urine output (-112.68 [-27.43-48.9], P = 0.17), incidence of AKI (RR = 1.05 [0.80-1.37], P = 0.72), and mortality rates (RR = 0.79 [0.42-1.47], P = 0.45) were found to be statistically insignificant. CONCLUSIONS Aminophylline administration in children with AKI reduces serum creatinine level without significant adverse effects or effect on the incidence of AKI, urine output, or mortality. Further, large-scale well-planned randomized controlled trials are needed to evaluate its use and its potential long-term effects.
Collapse
Affiliation(s)
- Saad Alsaadoun
- Department of Pediatric, Division of Pediatric Nephrology, Security Forces Hospital, Riyadh 13225, Saudi Arabia
| | - Faisal Rustom
- College of Medicine, AlFaisal University, Riyadh 11421, Saudi Arabia
| | - Hanan Abu Hassan
- Department of Pediatric Intensive Care, Prince Sultan Cardiac Center, PSMMC, Riyadh 11159, Saudi Arabia
| | - Hassan Alkhurais
- Department of Pediatrics, Security Forces Hospital, Riyadh 11481, Saudia Arabia
| | - Majed Aloufi
- Department of Pediatric Nephrology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
| | - Saeed Alzahrani
- Department of Pediatric Nephrology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
| | - Shireen Bakhsh
- Department of Pediatric Nephrology, Security Forces Hospital, Riyadh 13314, Saudi Arabia
| | - Sultan Al Dalbhi
- Department of Adult Nephrology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia,
Address for correspondence: Sultan Al Dalbhi, Department of Adult Nephrology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia. E-mail:
| |
Collapse
|