Characteristics of Acute Kidney Injury (AKI) in Children With Cancer and in the Bone Marrow Transplant Unit - An Analysis of an AKI Registry From a Tertiary Cancer Center

Sep 30, 2026

Detection and tracking of acute kidney injury (AKI) in children with cancer, particularly in Jordan and low- and middle-income settings, remain limited. This analysis reports AKI incidence, outcomes, risk factors, and related clinical parameters in children treated at King Hussein Cancer Center. Using an AKI registry with flag-based surveillance across the pediatric ward, BMT unit, PICU, and emergency room, AKI was defined and staged with KDIGO criteria. Among 4,482 patients, 473 AKI attacks occurred (2.9% of admissions) and 8.3% experienced at least one episode.

LanguageEnglish

CategoryHealthcare

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Pages11

Reading Time28 min

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Abstract

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Methodology

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Review began 11/21/2025 Review ended 12/07/2025 Published 12/10/2025 © Copyright 2025 Saca et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98875 Open Access Original Article Characteristics of Acute Kidney Injury (AKI) in Children With Cancer and in the Bone Marrow Transplant Unit: An Analysis of an AKI Registry From a Tertiary Cancer Center Edward J. Saca 1, 2, Hasan Hashem 3, Zebin Al Zebin 3 , Tariq Mohammad 3, Omar Banat Mohammad Salameh 4, Ezaldeen Azzeh 5, Mohammad Saleem 5, Rawad Rihani 6 3 , 1. Department of Pediatric Nephrology, King Hussein Cancer Center, Amman, JOR 2. Department of Pediatric Nephrology, Ibn Al Haytham Hospital, Amman, JOR 3. Department of Pediatrics, King Hussein Cancer Center, Amman, JOR 4. Department of Pediatrics, Ibn Al Haytham Hospital, Amman, JOR 5. Department of Pediatric Critical Care, King Hussein Cancer Center, Amman, JOR 6. Department of Pediatric Oncology, King Hussein Cancer Center, Amman, JOR Corresponding author: Edward J. Saca, [esaca@khcc.jo](esaca@khcc.jo) Abstract Objective Detection and tracing of acute kidney injury (AKI) in children with cancer in Jordan and the developing world are very limited. The objective of this paper is to report the incidence, the outcome, risk factors, as well as some clinical parameters associated with AKI in children with cancer. Methodology This study is based on an analysis of a registry that was established for children with cancer who develop AKI. The aim of the registry was to detect, trace, define risk factors, and maintain follow-up for children who develop AKI at King Hussein Cancer Center (KHCC) . A flag system was established for all children who develop AKI. The pediatric department at KHCC is composed of four locations. These include the pediatric ward, bone marrow transplant (BMT) unit, pediatric intensive care unit (PICU), and the emergency room (E/R) . Analysis was done in all locations. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results During the study period, there were 16,273 total hospital admissions, and the cancer registry included 4,482 unique patients. A total of 473 AKI attacks occurred, representing 2.9% of all admissions. These attacks occurred in 374 patients, indicating that 8.3% of cancer patients experienced at least one AKI episode. The mean follow-up duration was 2.27 ± 1.28 years. In the pediatric ward, 134 attacks of AKI were recorded (1 . 1% of admissions; 5. 7% of patients) . In the BMT unit, 117 attacks of AKI were recorded (4 .3% of admissions; 6.9% of patients) . In the PICU, 74 attacks of AKI were recorded (4 .4% of admissions; 10.8% of patients) . The most common place of developing AKI for patients at KHCC was in the home setting (community acquired) as 148 (31 .3%) of patients who had AKI presented to the E/R with AKI, 134 (28 .3%) had AKI while in the ward, 117 (24 . 7%) patients while in the BMT unit, and 74 (15 .6%) patients while in the ICU. Fifty-four (14 .4%) patients had two attacks, 15 (4 .0%) had three attacks, and five (1 .3%) had more than three attacks of AKI. The maximum stage of AKI reached was stage 1 in 204 (43 . 1%) patients, stage 2 in 167 (35 .3%) patients, and stage 3 in 102 (21 .6%) patients. In the PICU stage, three was the most common maximum stage reached. The main cause of AKI at KHCC was nephrotoxic medications in 204 (43 . 1%) of patients. High-dose methotrexate (MTx) was the most common single drug to cause AKI in 34 (16 . 7%) patients. The most common cause for home-acquired AKI was pre-renal in 47 (32%) patients. The most common malignancy in children who developed AKI was hematological in 230 (48 .6%) patients. Residual renal damage was detected

FAQs

What was the purpose of the AKI registry analysis?

To report the incidence, outcomes, risk factors, and associated clinical parameters of AKI in children with cancer treated at King Hussein Cancer Center.

How was AKI defined and staged in the study?

AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria.

What were the most common causes and settings for AKI?

The main cause at the center was nephrotoxic medications (43.1%), and the most common single drug was high-dose methotrexate (16.7%). The most common development setting was the home/community setting.

Sep 30, 2026

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