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. 2025 Dec;47(1):2465817.
doi: 10.1080/0886022X.2025.2465817. Epub 2025 Feb 23.

Acute kidney injury in hospitalized children with diphtheria in northwestern Nigeria: incidence and hospitalization outcomes

Olayinka Rasheed Ibrahim  1 , Abdurrazzaq Alege  2 , Michael Abel Alao  3 , Olanrewaju Timothy Adedoyin  4
Affiliations

Acute kidney injury in hospitalized children with diphtheria in northwestern Nigeria: incidence and hospitalization outcomes

Olayinka Rasheed Ibrahim et al. Ren Fail. 2025 Dec.

Abstract

Background: Despite the kidney being affected by diphtheria exotoxin, the extent of acute kidney injury (AKI) and its possible impact on outcomes remain unknown. This study examined the incidence, risk factors, and outcomes of AKI in children with diphtheria.

Methods: This was a prospective cohort study of confirmed diphtheria managed from July 1, 2023, to April 30, 2024, at a health facility in Nigeria. We obtained data on clinical and laboratory features and treatments received. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.

Results: We included 237 children with a median [interquartile range] age of 7.0 [4-10] years. Using KDIGO, 139 (58.6%) had AKI [stage 1:88 (37.1%); stage 2: 18 (7.6%); and stage 3: 33 (13.9%)]. Variables associated with AKI included age, sore throat, inability to swallow, difficulty breathing, nasal blockade, hypoxemia, nasal discharge, pallor, abnormal chest findings, hospitalization duration, vaccination status, white blood cells, lymphocytes, platelets, serum bicarbonate, sodium and potassium, and treatments received, p < 0.05. On multivariable logistic regression, predictors of AKI included age ≤ 60 months [AOR 2.75, 95% CI 1.27-5.95], dexamethasone [AOR 2.57, 95% CI 1.11-4.60], oxygen therapy [4.85, 95% CI 1.24-18.99], and ibuprofen [AOR 2.74, 95 CI% 1.16-6.44]. Mortality rate was 24.5% (58/237) and 33.1% (46/139) in AKI. The odds of deaths with AKI were 3.56 (95% CI 1.76-7.14).

Conclusion: There is a high incidence of AKI among children with diphtheria and increased odds of death. Factors that predicted AKI included younger age, oxygen therapy, and medications (ibuprofen and dexamethasone).

Keywords: Acute kidney injury; child; children; diphtheria; outcomes; risk factors.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Incidence of AKI.
See this image and copyright information in PMC

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