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Normal saline, the known but least-examined fluid therapy method for preventing heme-induced nephropathy in children with glucose 6 phosphate dehydrogenase deficiency: a randomized controlled clinical trial

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Abstract

Background

Glucose 6 phosphate dehydrogenase deficiency (G6PDd) is the most common enzyme deficiency in humans. Randomized clinical trials comparing the efficacy of different types of fluid therapy for prevention of acute kidney injury (AKI) following hemolysis in patients with G6PDd are lacking. The present study aimed to compare the efficacy of three different types of fluid administration, isotonic saline with or without acetazolamide versus bicarbonate solution in prevention of AKI among children with acute hemolysis due to G6PDd.

Methods

In this double-blind randomized controlled clinical trial, 120 infants and children with acute hemolysis due to G6PDd were randomly divided into three groups consisting of 40 participants in each group. Group A received normal saline. Group B received normal saline plus oral acetazolamide at a dose of 5 mg/kg/day, and group C received half saline plus 75 mEq/L sodium bicarbonate. The primary outcome of this study was the frequency of AKI among the different types of fluid administration.

Results

In this study, 72 (60%) patients were boys with the mean age and length of hospital stay of 3.9 ± 2.2 years and 54.4 ± 29.9 h, respectively. AKI as the primary outcome of this study occurred only in one patient in group C and the rate of AKI did not differ significantly among patients receiving different types of fluid resuscitation (P > 0.05).

Conclusion

Normal saline was equivalent to fluids containing alkalinizing agents in preventing heme-induced nephropathy in patients with G6PDd.

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Data availability

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.

References

  1. Harcke SJ, Rizzolo D, Harcke HT (2019) G6PD deficiency: an update. JAAPA 32:21–26

    Article  Google Scholar 

  2. Luzzatto L, Ally M, Notaro R (2020) Glucose-6-phosphate dehydrogenase deficiency. Blood 136:1225–1240

    Article  Google Scholar 

  3. Mesbah-Namin SA, Sanati MH, Mowjood A, Mason PJ, Vulliamy TJ, Noori-Daloii MR (2002) Three major glucose-6- phosphate dehydrogenase – deficient polymorphic variants identified in Mazandaran state of Iran. Br J Haematol 117:763–764

    Article  CAS  Google Scholar 

  4. Mortazavi Y, Mirimoghaddamm E, Pourfathollah AA (2003) 8th Annual Congress of the European Hematology Association. Hematol J 4:15

    Google Scholar 

  5. Pishva N, Amoozgar H (2001) Hyperbilirubinemia following exchange transfusion with G6PD deficient donor blood. Iran J Med Sci 26:143–145

    Google Scholar 

  6. Luzzatto L, Arese P (2018) Favism and glucose-6-phosphate dehydrogenase deficiency. N Engl J Med 378:60–71

    Article  CAS  Google Scholar 

  7. Ad-hoc working group of ERBP; Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, Van Biesen W (2012) A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 27:4263-4272

  8. Abdel Hakeem GL, Abdel Naeem EA, Swelam SH, El MorsiAboulFotoh L, El Mazary AA, AbdelFadil AM, AbdelHafez AH (2016) Detection of occult acute kidney injury in glucose-6-phosphate dehydrogenase deficiency anemia. Mediterr J Hematol Infect Dis 8:e2016038

    Article  Google Scholar 

  9. Moore PK, Hsu RK, Liu KD (2018) Management of acute kidney injury: Core Curriculum 2018. Am J Kidney Dis 72:136–148

    Article  Google Scholar 

  10. Perazella, MA, Rosner MH (2019) Clinical features and diagnosis of heme pigment-induced acute kidney injury. UpToDate. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-heme-pigment-induced-acute-kidney-injury. Accessed 7 February 2019

  11. Rasouli M (2019) Why 0.9% saline is not normal. Pediatr Nephrol 34:1301–1302

    Article  Google Scholar 

  12. Assadi F (2006) Acetazolamide for prevention of contrast-induced nephropathy: a new use for an old drug. Pediatr Cardiol 27:238–242

    Article  Google Scholar 

  13. Ronco C, Levin A, Warnock DG, Mehta R, Kellum JA, Shah S, Molitoris BA; AKIN Working Group (2007) Improving outcomes from acute kidney injury (AKI): report on an initiative. Int J Artif Organs 30:373-376

  14. Hropot M, Fowler N, Karlmark B, Giebisch G (1985) Tubular action of diuretics: distal effects on electrolyte transport and acidification. Kidney Int 28:477–489

    Article  CAS  Google Scholar 

  15. Mirbehbahani NB, SalamiKhanshan A, Safaian B, Mohammadian S, Ariannejad S, Masoomnia AR, Malekmarzban A, Rashidbaghan A (2015) Effect of sodium bicarbonate and sodium chloride on renal and hematologic factors in patients with glucose-6-phosphate dehydrogenase deficiency. Iran J Ped Hematol Oncol 5:157–165

    Google Scholar 

  16. Darbandi B, Noghbaei M, Mehrabian F, Jafroodi M (2014) Medical expenses of patients with favism admitted to 17th Shahrivar Hospital compared to G6PD enzyme screening cost, in north of Iran. Iran J Ped Hematol Oncol 4:53–56

    CAS  Google Scholar 

  17. Scharman EJ, Troutman WG (2013) Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother 47:90–105

    Article  Google Scholar 

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Acknowledgements

We sincerely appreciate Professor Farahnak Assadi for his warm cooperation and valuable recommendations. This study was the pediatric residency research thesis of the second author (Dr. Saba Emami) at Guilan University of Medical Sciences.

Funding

This study was financially supported by the Vice-Chancellor of Research at Guilan University of Medical Sciences.

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Authors and Affiliations

  1. Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran

    Afshin Safaei-Asl, Saba Emami, Adel Baghersalimi, Bahram Darbandi, Afagh Hassanzadeh Rad & Hamidreza Badeli

Authors
  1. Afshin Safaei-Asl
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  2. Saba Emami
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  3. Adel Baghersalimi
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  4. Bahram Darbandi
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  5. Afagh Hassanzadeh Rad
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  6. Hamidreza Badeli
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Contributions

Study concept and design: ASA, AB, BD, HRB. Acquisition, analysis, or interpretation of data: EN, SE, AHR. Drafting of the manuscript: ASA, SE, AHR, HRB. Critical revision of the manuscript for important intellectual content: ASA, SE, AB, BD, AHR, HRB. Administrative, technical, or material support: ASA, SE, AB, BD, HRB. Study supervision: ASA, AB, BD, HRB.

Corresponding author

Correspondence to Hamidreza Badeli.

Ethics declarations

Ethics approval and consent to participate

Informed consent was obtained from patients and parents/guardians. This study was approved by the Vice-Chancellor of Research at Guilan University of Medical Sciences (Code: IR.GUMS.REC.1398.026, Date: 2019–04-13). It was registered in the Iranian Registry of Clinical Trials (code: IRCT20090111001545N5).

Competing interests

The authors declare no competing interests.

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Safaei-Asl, A., Emami, S., Baghersalimi, A. et al. Normal saline, the known but least-examined fluid therapy method for preventing heme-induced nephropathy in children with glucose 6 phosphate dehydrogenase deficiency: a randomized controlled clinical trial. Pediatr Nephrol 38, 549–555 (2023). https://doi.org/10.1007/s00467-022-05594-2

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  • DOI: https://doi.org/10.1007/s00467-022-05594-2

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