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.