Aminophylline therapy improves urine output, useful as adjunct diuretic in children with AKI

The study of children around three months of age with more than half of them being females found a significant increase in urine output six and twenty-four hours following aminophylline therapy. There was a significant variation in this change in urine output across the age groups with time after controlling for participant characteristics including inotrope use.

The researchers found no statistically significant change in serum creatine post-aminophylline therapy but with significant age-related variation in serum creatinine with time.

Acute kidney injury is reported to be a frequent complication of children admitted to the pediatric ICU (intensive care unit). One key management modality of AKI is diuretics use to reduce fluid overload.

Aminophylline is a drug well known for its use in the treatment of bronchial asthma. However, it is also purported to have diuretic effects on the kidneys. Beatrice I. Nyann, University of Ghana Medical Centre, Legon, Accra, Ghana, and colleagues aimed to assess the effect of aminophylline in critically ill children with AKI in a retrospective cohort study.

For this purpose, the researchers conducted a retrospective chart review of children admitted to the paediatric ICU of the Red Cross War Memorial Children’s Hospital (RCWMCH) with acute kidney injury who received aminophylline (from 2012 to June 2018). Data captured and analyzed included underlying disease conditions, demographics, urine output, medications, fluid balance, and kidney function. Data analysis was done from thirty-four children.

The study revealed the following findings:

• There was an increase in urine output from a median of 0.4 mls/kg/hr at six hours before aminophylline administration to 0.6 mls/kg/hr at six hours and 1.6 mls/kg/hr at twenty-four hours post aminophylline therapy.
• The median urine output significantly varied across the age groups over the 24-h time period post-aminophylline, with the most response in the neonates.
• There was no significant change in serum creatinine levels six hours post-aminophylline administration [109—125.5 micromole/l].
• There were significant age-related changes in creatinine levels at six hours post-aminophylline therapy.

"Our study revealed an improvement in urine output with aminophylline therapy. However, we did not find any significant effect on serum creatinine levels with aminophylline use," the researchers wrote. "In the neonatal group, the effect of augmentation of urine output was more pronounced."

"There is a need for further studies to justify these findings due to the study's uncontrolled nature and small sample size," they concluded. "Despite these limitations, aminophylline should be considered as an adjunct diuretic in children with AKI."

Reference:

Nyann, B.I., Nourse, P., Masu, A. et al. Effects of aminophylline therapy on urine output and kidney function in children with acute kidney injury. Pediatr Nephrol (2023). https://doi.org/10.1007/s00467-023-06065-y