Factors associated with reduced kidney function in hospitalized children with dehydration

Dehydration-related kidney impairment is often underestimated. The study evaluated factors associated with reduced estimated glomerular filtration rate (eGFR) at admission in dehydrated children requiring intravenous fluids.

A prospective observational study involved 1-17-year-old children hospitalized with moderate or severe dehydration. Patients were stratified by admission eGFR: Group A (eGFR <90 mL/min/1.73 m²), Group B (eGFR ≥90 mL/min/1.73 m²). Demographic and clinical characteristics, ibuprofen and paracetamol exposure, chronic diseases, long-term medication use, birth characteristics, and laboratory parameters were compared.

Among 179 children, 90 were in Group A and 89 in Group B. Pre-admission ibuprofen use was more frequent in Group A (65.6% vs. 47.2%; unadjusted odds ratio [OR] 2.13, 95% confidence interval [CI] 1.17-3.89), as was paracetamol use (52.2% vs. 31.5%; unadjusted OR 2.38, 95% CI 1.29-4.38). Symptom duration before hospitalization was longer in Group A (median 48 vs. 24 h, p < 0.001) but showed poor discriminatory ability (area under the curve [AUC] = 0.655, p < 0.001). Numerically higher cumulative paracetamol exposure was observed in Group A, but the between-group difference was not statistically significant (p = 0.095), as well as the exploratory discriminatory analysis. (AUC = 0.616, 95% CI 0.487-0.745, p = 0.077). Severe dehydration was not statistically significantly associated with reduced admission eGFR (adjusted OR 1.96, 95% CI 0.97-3.98, p = 0.062). Respiratory illness was independently associated with reduced admission eGFR (adjusted OR 5.49, 95% CI 1.58-19.03, p = 0.007). Other clinical and laboratory parameters did not differ.

Prolonged symptoms before hospitalization and respiratory illnesses as the primary cause of dehydration were associated with reduced admission eGFR. Age, medication exposure, and comorbidities were not independently associated with reduced admission eGFR after adjustment; birth-weight distributions and laboratory parameters did not differ significantly between groups.