Prevalence of Chemotherapy-Associated Acute Kidney Injury in Children With Solid Versus Non-Solid Tumors at a Tertiary Pediatric Center

Abstract

Background: Chemotherapy-associated acute kidney injury (AKI) is a significant complication in pediatric oncology, yet variation in AKI burden between children with solid and non-solid tumors remains insufficiently characterized. Understanding tumor-specific differences in renal vulnerability is essential for improving monitoring strategies and mitigating treatment-related morbidity. Objective: To determine the prevalence of chemotherapy-associated AKI in children with solid versus non-solid tumors treated at a tertiary pediatric center and to identify clinical factors associated with increased renal risk. Methods: A cross-sectional observational study was conducted among 60 pediatric oncology patients, with equal representation of solid and non-solid tumors. Demographic, clinical, and chemotherapy-related variables were collected through standardized chart review. AKI was defined using KDIGO pediatric serum creatinine criteria. Statistical analyses included group comparisons and multivariable logistic regression to identify predictors of AKI while adjusting for confounders. Results: AKI occurred in 35.0% of the cohort, with higher prevalence among solid tumor patients (43.3%) compared with those with non-solid tumors (26.7%). Solid tumor patients exhibited greater rises in peak serum creatinine (0.98 vs. 0.82 mg/dL). Nephrotoxic chemotherapy exposure (adjusted OR 3.41) and dehydration (adjusted OR 2.77) were significant predictors of AKI. Conclusion: Children with solid tumors experience a higher burden of chemotherapy-associated AKI, driven primarily by nephrotoxic drug exposure and modifiable clinical factors. Enhanced renal surveillance and preventive measures are warranted in high-risk groups.