Risk factors for acute kidney injury in pediatric intensive care units: a systematic review and meta-analysis

Acute kidney injury (AKI) is one of the common and severe complications in pediatric intensive care units (PICUs), closely associated with increased mortality, prolonged hospital stays, and heightened healthcare burdens among pediatric patients. A meta-analysis examined the associated risk factors for AKI in PICUs patients. A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library databases from their inception to August 20, 2025, to identify observational studies reporting risk factors for AKI in pediatric PICU patients. Two researchers independently performed literature screening, data extraction, and quality assessment. Stata 15 software was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs), assess heterogeneity, and analyze publication bias. Thirteen articles involving 8557 patients were included, meta-analysis results suggested that age (per year increase) OR = 1.64, 95%CI (1.03, 2.61), female OR = 1.45, 95%CI (1.11, 1.91), sepsis OR = 5.98, 95%CI (3.10, 11.51), MODS OR = 3.92, 95%CI (2.29, 6.71), coagulopathy OR = 2.24, 95%CI (1.56, 3.24), nephrotoxic drugs OR = 2.87, 95%CI (2.16, 3.80), mechanical ventilation OR = 2.39, 95%CI (1.28, 4.47)] were associated with the occurrence of AKI in PICUs. The Meta-analysis results of this study revealed several important AKI risk factors, including age, gender, sepsis, multiple organ dysfunction, coagulation disorders, nephrotoxic drug use and mechanical ventilation.