(A-328) Association of Dexamethasone Prescription with Acute Kidney Injury among Hospitalized Children

Sunday, August 24, 2025

12:00 PM - 1:30 PM ET

Co-Author(s)

YH

Yuanhui Hu

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province 2. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education 4. West China School of Pharmacy, Sichuan University, China (People's Republic)
HS

Haoxin Song

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province 2. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, China (People's Republic)
JY

Jiarong Yuan

West China School of Pharmacy, Sichuan University, China (People's Republic)
MZ

Miao Zhang

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province 2. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education 4. West China School of Pharmacy, Sichuan University, China (People's Republic)
TG

Tingting Gaoyang

West China School of Pharmacy, Sichuan University, China (People's Republic)
ZX

Zheng Xu

West China School of Pharmacy, Sichuan University, China (People's Republic)
QP

Qilin Peng

West China School of Medicine, Sichuan University, China (People's Republic)
YX

Yao Xu

West China School of Pharmacy, Sichuan University, China (People's Republic)
YZ

Yu Zhu

Department of Pediatrics, West China Second University Hospital, Sichuan University, China (People's Republic)
LH

Liang Huang

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province 2. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, China (People's Republic)
LZ

Linan Zeng

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province 2. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education 4. West China Biomedical Big Data Center, West China Hospital, Sichuan University, China (People's Republic)

Presenting Author(s)

HL

Hailong Li

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province 2. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, China (People's Republic)

Co-Author(s)

LZ

Lingli Zhang

1. Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University; Children's Medicine Key Laboratory of Sichuan Province 2. NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation 3. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education 4. West China Biomedical Big Data Center, West China Hospital, Sichuan University 5. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, China (People's Republic)

Background: Dexamethasone is commonly used in hospitalized children, especially in those with inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, its impact on acute kidney injury (AKI) remains controversial.

Objectives: To examine the association of dexamethasone use with AKI among hospitalized children in China.

Methods: Children aged 1 to 18 years who were hospitalized for at least two days between January 1 and December 31, 2022 were included in this retrospective cohort study. Patients without available serum creatinine (Scr) tests or with severe renal impairment on admission were excluded. Participants were divided into two groups based on dexamethasone use. Acute kidney injury was defined as an increase in SCr level of 26.5 μmol/L or higher within 48 hours or by 50% or more over the baseline value. Baseline SCr level was calculated for each patient as the mean of all available SCr values 7 days prior to dexamethasone administration in dexamethasone-exposed group or the first two available Scr tests after admission in non-exposed group. A two-way stepwise logistic regression was used to select variables, followed by multifactorial logistic regression to assess the association between the use of dexamethasone and the risk of AKI. Subgroup analyses were performed based on baseline variables that differed. Two sensitivity analyses were performed: propensity score matching (PSM) and inverse probability of censoring weighting (IPCW).

Results: A total of 9,178 patients were hospitalized, of whom 1,978 met the criteria for inclusion, including 685 dexamethasone users and 1,282 non-users. 96 (14.0%) AKI and 84 (6.6%) AKI events were detected respectively in dexamethasone-exposed and non-exposed group with 6.6 events per 1,000 person-days. Before adjusting for confounders, dexamethasone was associated with an increased risk of AKI (Crude OR 2.33, 95% CI 1.70–3.17, P < 0.01). After adjustment, dexamethasone was associated with a decreased risk of AKI, though the association were not statistically significant (Adjusted OR 0.98, 95% CI 0.64–1.51, P = 0.94). A decreased risk of AKI was observed at male, younger ages ( < 12 years), without comorbid tumors, chronic kidney disease, and immunosuppressants, but none of these were statistically significant. Both sensitivity analyses suggested that dexamethasone may reduce the risk of AKI (PSM: Adjusted OR 0.66, 95% CI 0.37–1.17, P = 0.20; IPCW: Adjusted HR 0.78, 95% CI 0.53–1.12, P = 0.17), although the results were not statistically significant.

Conclusions: Dexamethasone may be associated with decreased risk of AKI in hospitalized children. However, large-scale prospective studies are needed to further examine the association between dexamethasone and the risk of AKI in children.