Intravenous Acyclovir-Associated Acute Kidney Injury in Pediatric Patients: A Retrospective Study
| Author | Abdulrahman Alotaibi | en |
| Author | Nada A. Alsaleh | en |
| Author | Abeer Alsmari | en |
| Author | Hessa Al Muqati | en |
| Author | Raghad Alenazi | en |
| Author | Muneerah Al Boushal | en |
| Author | Ohoud Almutairi | en |
| Author | Majed Nahari | en |
| Author | Mohammed Alnuhait | en |
| Issued Date | 2026-04-30 | en |
| Abstract | Background: Acyclovir is widely used to manage herpesvirus infections in pediatric populations but is associated with potential nephrotoxicity, particularly in intravenous formulations. Limited local data are available on the incidence and risk factors of acyclovir-induced acute kidney injury (AKI) in children in Saudi Arabia. Objectives: To assess the incidence of AKI among hospitalized pediatric patients receiving intravenous acyclovir and evaluate the impact of hydration protocols and co-administered nephrotoxic agents. Methods: This retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital, including pediatric inpatients under 14 years of age who received IV acyclovir between June 2020 and December 2023. The most common acyclovir dose was 10 mg/kg (44%), and the median treatment duration was 4 days (range 2 - 77). Patients were managed in the Neonatal Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), or general pediatric wards according to clinical severity. Patients with pre-existing kidney disease, missing creatinine values, or short-duration therapy were excluded. Demographic, clinical, laboratory, and medication data were extracted from electronic medical records. Acute kidney injury was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Hydration levels and concurrent nephrotoxic drug exposure were analyzed. Results: A total of 100 patients were included, with a median age of 22.5 months. The majority received maintenance intravenous fluids (IVF) hydration, and 37% received IV fluids throughout the acyclovir treatment course. Despite 59% of patients receiving at least one nephrotoxic medication, only one case of AKI was identified (1.0%; 95% CI, 0.03 - 5.45%). The most commonly co-administered nephrotoxic agent was vancomycin. No significant decline in estimated glomerular filtration rate (eGFR) or elevation in serum creatinine was observed across the cohort. Conclusions: The incidence of AKI was low among pediatric inpatients receiving IV acyclovir. Because of the very low event rate and lack of a comparison group, causal conclusions regarding the effect of hydration cannot be made. Further multicenter studies are warranted to better define risk factors and preventive strategies. | en |
| DOI | https://doi.org/10.5812/ijpediatr-168331 | en |
| Keyword | Acyclovir | en |
| Keyword | Acute Kidney Injury | en |
| Keyword | Pediatrics | en |
| Keyword | Nephrotoxicity | en |
| Keyword | Hydration | en |
| Keyword | Drug Safety | en |
| Keyword | Risk Factors | en |
| Keyword | Vancomycin | en |
| Publisher | Brieflands | en |
| Title | Intravenous Acyclovir-Associated Acute Kidney Injury in Pediatric Patients: A Retrospective Study | en |
| Type | Research Article | en |
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