Acute kidney injury following intravenous acyclovir in children.

Blake J Sandery, Jonathan H Erlich, Sean E Kennedy

Archives of disease in childhood 2020 Dec

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The objective of this study was to describe the incidence of acute kidney injury (AKI) in children receiving intravenous acyclovir and determine risk factors that may be associated with it. This was a retrospective cohort study, conducted by chart review. The study was conducted across two paediatric hospitals. All inpatients that received intravenous acyclovir in records from January 2015 to December 2015 were reviewed. Only patients with creatinine measurements taken before and after starting acyclovir were included in the study. The main outcome measure was the development of AKI following intravenous acyclovir administration, with AKI defined according to change in serum creatinine. 150 patients were included in the analysis. Patients' ages ranged from 2 days to 18.6 years. 27 children (18%) developed at least stage 1 AKI. Children receiving cancer treatment developed AKI more frequently than children with other diagnoses; 29.3% vs 10.9% (OR 3.4, 95% CI 1.5 to 8.2, p=0.008). The baseline estimated glomerular filtration rate (eGFR) was higher in those children who developed AKI. 34% of children had an eGFR >120 mL/min/1.73 m2 prior to acyclovir use. 31% of these children developed AKI compared with only 11% of those with a normal baseline eGFR (OR 3.6, 95 CI 1.3 to 10.1, p=0.02). Baseline eGFR was a significant predictor of AKI in a multivariable analysis that included cumulative dose and treatment duration (OR 1.02, p=0.013). AKI following intravenous acyclovir exposure is common in children. This study raises the possibility that glomerular hyperfiltration is a previously unrecognised risk factor for acyclovir-induced AKI. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Blake J Sandery, Jonathan H Erlich, Sean E Kennedy. Acute kidney injury following intravenous acyclovir in children. Archives of disease in childhood. 2020 Dec;105(12):1215-1219