Acute kidney diseases and disorders in children with bloodstream infection: frequency, predictors, and outcomes.

BACKGROUND

Pediatric acute kidney diseases and disorders (AKDs) are a new concept defined as kidney damage lasting 7-90 days from onset. Data on AKD after bloodstream infection (BSI) are limited.

METHODS

This single-center, retrospective observational study included patients aged < 20 years with BSI who were subsequently diagnosed with acute kidney injury (AKI) and/or AKD between 1 May 2013 and 31 May 2023. The index day was the date of the first positive blood culture. AKI (days 0-7) and AKD (days 7-90) were defined according to the Kidney Disease: Improving Global Outcomes/Acute Disease Quality Initiative criteria. Patients were categorized as those with AKI without AKD, AKD with AKI, and AKD without AKI. Primary comparisons included AKD (with/without AKI) versus AKI without AKD. Logistic regression analyses were conducted to identify predictors of AKD.

RESULTS

Among 1427 patients with positive blood cultures, 197 developed kidney dysfunction. The final cohort comprised 96 patients, including 41 patients (43%) who developed AKD. In the final cohort, 55 patients had AKI without AKD, 33 patients had AKD with AKI, and 8 patients had AKD without AKI. By multivariable logistic regression analysis, younger age (odds ratio, 0.91; 95% confidence interval, 0.84-0.99; P = 0.046) was independently associated with AKD after adjusting for intensive care unit onset, glycopeptide exposure, and white blood cell count. Compared to AKI without AKD (0/55), those with AKD (with/without AKI) had higher rates of death (6/41, 15%) and major adverse kidney events at days 30 (7/41, 17%) and 90 (8/41, 20%). All adverse outcomes occurred in the AKD with AKI subgroup.

CONCLUSIONS

In children with bloodstream infection-associated kidney dysfunction, AKD occurred in a substantial proportion, including those not meeting the AKI criteria. Younger age was associated with AKD development.