Diazepam's Role in Acute Kidney Injury Risk in Children

Impact of Diazepam on Acute Kidney Injury in Pediatric Patients

Acute kidney injury (AKI) is a critical condition that can lead to significant morbidity and mortality in pediatric patients. The use of various medications, including diazepam, has raised concerns regarding their nephrotoxic potential. Diazepam, a benzodiazepine commonly used for its anxiolytic and sedative properties, has been associated with renal complications in children, particularly when administered intravenously in hospital settings. A recent observational cohort study revealed a significant correlation between diazepam exposure and the risk of AKI in hospitalized children (Zhang et al., 2025).

The study included 3,018 hospitalized children, with 148 receiving diazepam and 2,870 serving as controls. The findings indicated that those exposed to diazepam had an odds ratio of 1.85 for developing AKI, highlighting a nearly doubled risk compared to those who did not receive the medication. This correlation persisted even after adjusting for various covariates, such as age and baseline serum creatinine levels. The implications of these findings are profound, suggesting that clinicians should exercise caution when prescribing diazepam, especially in vulnerable pediatric populations.

Association Between Diazepam Use and Kidney Function Decline

Research has consistently shown that certain medications can adversely affect kidney function, and diazepam is no exception. The association between diazepam and AKI presents a challenge for healthcare providers, especially in pediatric settings where patients may have varying degrees of renal maturity and underlying health conditions. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines classify AKI based on serum creatinine levels and urine output, providing a framework for identifying and managing this condition effectively (Zhang et al., 2025).

The increased risk of AKI associated with diazepam may arise from several mechanisms. First, diazepam can cause vasodilation, potentially leading to decreased renal perfusion. Additionally, the medication’s sedative effects may mask signs of dehydration or other renal stressors that could exacerbate kidney injury. The interplay between diazepam and other nephrotoxic agents, such as non-steroidal anti-inflammatory drugs (NSAIDs) or diuretics, may further complicate the clinical picture, necessitating careful monitoring and a multidisciplinary approach to management.

Key Risk Factors for Acute Kidney Injury in Hospitalized Children

Identifying risk factors for AKI in pediatric patients is crucial for prevention and management. Factors such as age, baseline kidney function, and concurrent use of certain medications can significantly influence the risk of developing AKI. The aforementioned study by Zhang et al. (2025) identified several critical risk factors, including:

• Age: Younger children, particularly neonates and infants, are at a higher risk due to immature renal function.
• Chronic Kidney Disease (CKD): Patients with pre-existing renal impairment are more susceptible to the nephrotoxic effects of medications, including diazepam.
• Concurrent Medications: The use of diuretics, NSAIDs, and other nephrotoxic agents can compound the risk of AKI. In the study, the use of diuretics was linked to a higher incidence of AKI (OR = 1.85), emphasizing the need for careful medication management in this population.

Table 1 summarizes the identified risk factors and their associated odds ratios for developing AKI in children exposed to diazepam.

Clinical Implications of Diazepam in Pediatric Care Settings

The implications of diazepam use in pediatric patients extend beyond the immediate risk of AKI. Clinicians must consider the broader context of medication management in children, particularly regarding sedation and anxiety management during surgical procedures or emergency care. The potential for diazepam to induce significant renal complications necessitates a comprehensive approach that includes:

1. Thorough Patient Assessment: Prior to administering diazepam, healthcare providers should conduct a detailed assessment of the patient’s renal function and consider alternative medications with a more favorable safety profile.

2. Medication Monitoring: Continuous monitoring of renal function, particularly in high-risk populations, is essential. This may involve regular serum creatinine measurements and urine output assessments to identify any early signs of renal impairment.

3. Multidisciplinary Collaboration: Engaging nephrologists, pediatricians, and pharmacists in the medication management process can enhance patient safety and optimize therapeutic outcomes.

4. Patient and Family Education: Providing education to patients and their families about the potential risks associated with diazepam use and the importance of reporting any unusual symptoms can empower them to play an active role in their healthcare.

Recommendations for Safe Diazepam Administration in Children

To mitigate the risks associated with diazepam use in pediatric patients, the following recommendations are proposed:

• Limit Use to Indicated Cases: Prescribe diazepam only when necessary for managing acute anxiety or seizures, considering non-benzodiazepine alternatives when appropriate.

• Dosage Considerations: Administer the lowest effective dose and consider adjusting the dosage based on the child’s weight and renal function.

• Preoperative Screening: For children undergoing surgical procedures, preoperative assessments should include renal function evaluations and an assessment of other medications that may interact with diazepam.

• Post-Administration Monitoring: Implement a protocol for monitoring patients for signs of AKI post-administration, particularly in settings such as emergency departments or surgical recovery areas.

• Develop Clinical Guidelines: Institutions should develop and disseminate clinical guidelines that address the safe use of diazepam in pediatric populations, focusing on prevention strategies and early identification of AKI.

FAQ

What is the primary concern regarding diazepam use in children?

The primary concern is the increased risk of acute kidney injury (AKI) associated with diazepam exposure in pediatric patients.

How was the association between diazepam and AKI determined?

An observational cohort study involving 3,018 hospitalized children demonstrated that those exposed to diazepam had a significantly higher risk of developing AKI compared to those who did not receive the medication.

What are some risk factors for AKI in children?

Key risk factors include age (younger children are more vulnerable), chronic kidney disease, and the use of concurrent medications such as diuretics and NSAIDs.

What recommendations can help ensure safe diazepam administration in children?

Recommendations include limiting use to indicated cases, administering the lowest effective dose, conducting preoperative screening for renal function, and implementing post-administration monitoring protocols.

References

1. Zhang, M., Huang, L., Zhu, Y., Zeng, L., Cheng, G., Li, H., & Zhang, L. (2025). Diazepam exposure associated with an increased risk of acute kidney injury in children: an observational cohort study. BMC Pediatrics. https://doi.org/10.1186/s12887-025-05494-y