Acute kidney injury following intravenous acyclovir in children

Sandery, Blake; Erlich, Jonathan; Kennedy, Seán

doi:10.1136/archdischild-2019-317990

Cited by 8 publications

(3 citation statements)

References 36 publications

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“…Eighteen children (21.7%) had new-onset AKI during hospital stay, none requiring RRT. These findings were similar to that reported by Sandery et al (22), where 12 of 27 patients (44%) who developed AKI remained in stage 1 at their last creatinine measurement (23). Nephrotoxicity associated with IV acyclovir is common and necessitates monitoring of renal function (12–14).…”

Section: Discussionsupporting

confidence: 92%

An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India

Adarsha

Samprathi

Sankhyan

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To identify the prevalence of herpes simplex encephalitis (HSE), factors influencing the duration of empirical acyclovir and frequency of acute kidney injury (AKI) in children with acute encephalitis syndrome (AES). Design: Prospective observational study. Setting: Pediatric Emergency Department and PICU of a tertiary hospital in Northern India. Patients: All consecutive, eligible children between 1 month and 12 years old presenting with AES, defined as altered consciousness for greater than 24 hours (including lethargy, irritability, or a change in personality) and two or more of the following signs: 1) fever (temperature ≥ 38°C) during the current illness, 2) seizures or focal neurological signs, 3) cerebrospinal fluid (CSF) pleocytosis, 4) electroencephalogram, and/or 5) neuroimaging suggesting encephalitis, who received at least one dose of acyclovir. Interventions: None. Measurements and Main Results: Of the 101 children screened, 83 were enrolled. The median (interquartile range [IQR]) age was 3 years (1–6 yr). Thirty-one children (37.3%) were diagnosed with AES, of which four were labeled as probable HSE (three based on MRI brain, one based on serology). Scrub typhus, dengue, Japanese encephalitis, and mumps were the other infective causes. The median (IQR) duration of acyclovir therapy was 72 hours (24–264 hr); 21 children (25.3%) received acyclovir for less than 24 hours and 11 (13.3%) for greater than or equal to 14 days. New-onset AKI was seen in 18 children (21.7%) but was mostly transient. Death (n = 8, 9.6%) and discontinuation of care due to futility or other reasons (n = 15, 18%) were noted in 23 children (28%). Factors associated with duration of acyclovir greater than 7 days, on univariable analysis, were lower modified Glasgow Coma Score at admission, requirement of invasive ventilation, invasive intracranial pressure monitoring, and CSF pleocytosis (5–500 cells). On multivariable analysis, only CSF pleocytosis of 5–500 cells was associated with duration of acyclovir greater than 7 days. Conclusions: Given the low prevalence of HSE, and the risk of AKI, this study sensitizes the need to review our practice on initiation and stopping of empirical acyclovir in children with acute encephalitis.

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Section: Discussionsupporting

confidence: 92%

An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India

Adarsha

Samprathi

Sankhyan

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

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“…Hyperfiltration state may indicate kidneys have little reserve capacity, thus intolerable to nephrotoxic insults and prone to incidence of AKI. Sandery et al also demonstrated in their study that the elevated baseline eGFR was a significant risk factor of AKI in children receiving nephrotoxic drugs, and attributed the pathogenesis to GH [27].…”

Section: Discussionmentioning

confidence: 90%

Retrospective analysis on incidence and risk factors of early onset acute kidney injury after lung transplantation and its association with mortality

Wang

Zhang

et al. 2021

Renal Failure

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Objectives: Acute kidney injury (AKI) is a common complication after lung transplantation (LTx) which is closely related to the poor prognosis of patients. We aimed to explore potential risk factors and outcomes associated with early post-operative AKI after LTx. Methods: A retrospective study was conducted in 136 patients who underwent LTx at our institution from 2017 to 2019. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline. Univariate and multivariate analyses were conducted to identify risk factors related to AKI. The primary outcome was the incidence of AKI after LTx. Secondary outcomes were associations between AKI and short-term clinical outcomes and mortality. Results: Of the 136 patients analyzed, 110 developed AKI (80.9%). AKI was associated with higher baseline eGFR (odds ratio (OR) 1.01 (95% confidence interval (CI): 1.00-1.03)) and median tacrolimus (TAC) concentration (OR 1.15 (95% CI: 1.02-1.30)). Patients with AKI suffered longer mechanical ventilation days (p ¼ .015) and ICU stay days (p ¼ .011). AKI stage 2-3 patients had higher risk of 1-year mortality (HR 16.98 (95% CI: 2.25-128.45)) compared with no-AKI and stage 1 patients. Conclusions: Our results suggested early post-operative AKI may be associated with higher baseline eGFR and TAC concentrations. AKI stage 1 may have no influence on survival rate, whereas AKI stage 2-3 may be associated with increased mortality at 1-year.

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“…41–43 There was also increasing evidence for the nephrotoxicity associated with nucleoside analogs such as acyclovir and ganciclovir. 44–47 Our study showed that foscarnet was associated a significantly lower risk of hospital-acquired AKI compared with acyclovir.…”

Section: Discussionmentioning

confidence: 70%

Associations between Different Antivirals and Hospital-Acquired Acute Kidney Injury in Adults with Herpes Zoster

Xu,

Gao,

Zhang

et al. 2024

CJASN

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Background: To examine the association of use of different antivirals with hospital acquired acute kidney injury (AKI) among Chinese adults with herpes zoster. Methods: The study selected 3273 adult patients who received antiviral therapy for herpes zoster during hospitalization from the China Renal Data System (CRDS). We identified and staged AKI using patient-level serum creatinine data according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We compared the relative risks of hospital acquired AKI among patients treated with different antivirals using Cox proportional hazards models. Results: Among 3273 patients, 1480 (45%), 681 (21%), 489 (15%) and 623 (19%) were treated with acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet, respectively. During the follow-up period, a total of 111 cases of hospital acquired AKI occurred, predominantly classified as AKI stage 1. The cumulative incidences of hospital acquired AKI were 5%, 3%, 3% and 1%, in the patients receiving acyclovir/valacyclovir, ganciclovir, penciclovir/famciclovir, and foscarnet, respectively. Compared with acyclovir/valacyclovir, penciclovir/famciclovir/ganciclovir and foscarnet were associated with a lower risk of hospital acquired AKI, with an adjusted hazard ratio [aHR] of 0.59 (95% CI, 0.37-0.94) and 0.27 (95% CI, 0.11-0.63), respectively. Compared with intravenous acyclovir, intravenous penciclovir/ganciclovir and foscarnet were associated with a lower risk of hospital acquired AKI with an aHR of 0.53 (95% CI, 0.29-0.98) and 0.31 (95% CI, 0.12-0.76), respectively. The associations were consistent across various subgroups and sensitivity analyses. Conclusions: Among antiviral therapies for herpes zoster, we found different risks of hospital acquired AKI among the patients receiving different antivirals, in particular, those administered intravenously. Among intravenous antivirals, acyclovir was associated with highest risk of hospital acquired AKI, followed by penciclovir/ganciclovir and foscarnet. Confirmation studies with large samples from other populations are warranted.

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Acute kidney injury following intravenous acyclovir in children

Cited by 8 publications

References 36 publications

An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India

An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India

Retrospective analysis on incidence and risk factors of early onset acute kidney injury after lung transplantation and its association with mortality

Associations between Different Antivirals and Hospital-Acquired Acute Kidney Injury in Adults with Herpes Zoster

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