Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort (original) (raw)
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Incidence and Risk Factors of Early Onset Neonatal AKI
Clinical Journal of the American Society of Nephrology, 2019
Background and objectivesNeonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week.Design, setting, participants, & measurementsThe international retrospective observational cohort study, Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2–7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization.ResultsTwenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer du...
Acute kidney injury in premature newborns—definition, etiology, and outcome
Pediatric Nephrology, 2017
Background Neonatal acute kidney injury (AKI) is common and is associated with poor outcomes. New criteria for the diagnosis of AKI were introduced based on the increase in serum creatinine (SCr) levels and/or reduction of urine output (UOP). Yet, there is no generally accepted opinion so far, which criteria (whether SCr, UOP, or their combination) are the most appropriate to diagnose neonatal AKI. Methods The retrospective study included 195 prematurely born neonates who fulfilled all inclusion criteria (with at least two SCr measurements). In all the neonates included in the study, AKI was diagnosed using three different definitions: (1) SCr criteria (an increase in SCr values of ≥0.3 mg/dl), (2) UOP criteria (UOP < 1.5 ml/kg/h), and (3) SCr + UOP criteria. Results Out of all of the patients the study included, 85 (44%) were diagnosed with AKI. The neonates who had AKI had a significantly lower gestational age, birth weight, and Apgar score, longer duration of mechanical ventilation, and a higher mortality rate. SCr + UOP criteria showed higher sensitivity for prediction of death compared to SCr or UOP alone (p = 0.0008, 95% CI 0.040-0.154, and p = 0.0038, 95% CI 0.024-0.125, respectively). If only SCr or only UOP criterion are used, they fail to identify AKI in 61 and 67%, respectively. AKI was an independent risk factor for death (OR 7.4875; CI 3.1887-17.5816). Conclusions Similar to other studies, our data showed that neonates with AKI have worse outcome. Neonatal AKI defined based on SCr + UOP criteria is a better predictor of death than neonatal AKI defined based only on the SCr or UOP criteria. Also, by using SCr + UOP criteria for diagnosing neonatal AKI, more patients with AKI are recruited than when only one of those criteria is used.
Pediatric research, 2017
Normal developmental changes during postnatal life hinder the development of an AKI definition and advancement of neonatal AKI research. This report summarizes the expert discussion at a National Institute of Diabetes and Digestive and Kidney Diseases sponsored neonatal AKI workshop, on knowledge gaps in defining neonatal AKI. The most important knowledge gaps and neonatal AKI definition research recommendations were agreed upon and defined. Several challenges were identified in defining neonatal AKI using serum creatinine (SCr) and urine output criteria applied in adults and children. Neonate-tailored AKI definitions incorporating neonatal physiology should be developed and tested, with a focus on applicability across gestational and postnatal age groups. Studies evaluating associations of AKI with short and long-term outcomes and validating new AKI biomarkers are research priorities.Pediatric Research accepted article preview online, 12 June 2017. doi:10.1038/pr.2017.136.
2017
AKI is associated with increased mortality in neonates but there is lack of studies regarding prevalence and outcome of AKI in neonates in western Rajasthan. The aim is to study the prevalence, co-morbidities and outcome of AKI in critically ill neonates. This single center prospective observational study was conducted for one year at tertiary care out born neonatal intensive care unit (NICU). 1004 neonates fulfilled admission criteria, out of them 93 neonates suffered from AKI on admission or later. AKI was categorized by AKIN staging. Associated co-morbidities were identified and clinical course followed till discharge/expiry. Analysis of data was done by using SPSS version 15 & differences in distribution of categorical variables were analyzed by chi square test. AKI found to be as common as 9.26% in critical ill neonates (stage 3 in 37.63%). AKI was more common in SGA and home delivered neonates. These neonates required higher percentage of inotropic support (51.61%) and mechani...
Pediatric Nephrology, 2009
The independent impact of acute kidney injury (AKI) on survival in very low birthweight (VLBW; ≤1,500 g) critically ill infants has not been studied. Cases (nonsurvivors n=68) were matched to, at most, two controls (survivors n=127) by incidence density sampling with replacement, birthweight (± 50 g), gestational age (± 1 week), and availability of serum creatinine (SCr) levels before the index patient's time of death. Maternal/infant demographic characteristics, co-morbidities, complications and interventions were explored. No difference existed between patients and controls in mean gestational age and birthweight (the matching variables), race, or gender. Compared with the controls, cases had younger mothers, less placental separation, fewer occurrences of hyponatremia, more intra-ventricular hemorrhage, and received chest compressions and cardiac drugs. A 1 mg/dl increase in SCr was associated with almost two-times higher odds of death [odds ratio (OR)=1.94, 95% confidence interval (95% CI) 1.13-3.32]. OR increased when confounding variables were adjusted (adjusted OR 3.44, 95% CI 1.23-9.61). Similarly, a 100% increase in SCr from trough level was associated with an increased OR=1.53 (95% CI 1.14-2.04) and became stronger, after adjustment of variables (adjusted OR=1.90, 95% CI 1.10-3.27). After confounding variables had been controlled for, AKI was independently associated with mortality in VLBW infants. Further prospective multi-center studies are needed to determine whether this association exists.
Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants
Pediatric Nephrology, 2011
The aim of this study was to determine the incidence, risk factors, and outcome of acute kidney injury (AKI) in extremely low birth weight (ELBW) infants. In a case-control study, medical records of all ELBW infants who were admitted to our Neonatal Intensive Care Unit (NICU) between 1 January 2000 and 31 January 2008 were reviewed. During the study period, 12.5% (59/472) of all ELBW infants developed AKI. Forty-six infants with available medical records were matched to 46 controls. The mean gestational age and birth weight of infants with AKI and their controls were 24.7±1.8 vs. 24.9±1.9 weeks (p=0.61) and 614± 128 vs. 616±127 g (p=0.93), respectively. Infants with AKI had a higher mean airway pressure, a lower mean arterial blood pressure, and higher exposure to cefotaxime than their controls. Infants with AKI also had an increased mortality in comparison to their controls [33/46 (70%) vs. 10/46 (22%), respectively; p < 0.0001), and oliguric patients had a higher mortality than nonoliguric patients [31/38 (81%) vs. 2/8 (25%), respectively, p=0.003]. Based on our results, we conclude that a high mean airway pressure, low blood pressure, and the use of cefotaxime are associated with renal failure in ELBW infants. AKI in ELBW infants is also associated with an increased mortality, especially in the presence of oliguria.
Prognostic Factors and Mortality Rate in Neonates with Acute Renal Injury in NICU
Introduction: Acute Renal Injury (AKI) is a frequent clinical condition in the Neonatal Intensive Care Units (NICUs). Most AKI causes are preventable; performing rapid preventive, diagnostic, and therapeutic measures could prevent the potential complications. The present study was conducted to define the risk factors and mortality rates of neonates with and without AKI admitted in the NICU of a tertiary care hospital. Materials and Methods: Demographic and biochemical data of NICU of Mahdieh Hospital were collected and analyzed. More than twofold increase in normal serum creatinine level or >0.8 mg/dl (for infants > 4 days age) was defined as AKI. All newborns were divided into two groups: with and without AKI. Risk factors and mortality rates were compared in the 2 groups. Results: The mortality rate of newborns with AKI was 4.5%. The other risk factors for mortality in neonates with AKI were as follows: Hyaline Membrane Disease (HMD) (P <0.03), using mechanical ventilation (P <0.041), using surfactant (P <0.04), first minute Apgar score <5, PCO2 >60 mmHg (P <0.035), birth weight < 2500 g (P <0.003) and serum creatinine (SCr) level >1 mg/dl (P <0.003). ROC Curve revealed that low birth weight was the most significant risk factor for mortality of neonates with AKI admitted in the NICU. Conclusions: Mortality related to AKI was associated with HMD, using mechanical ventilation, the need to surfactant use, low Apgar score, high blood PCO2, high serum creatinine level, and low birth weight.
The prognostic value of serum creatinine dynamics in neonates
Research Square (Research Square), 2024
Background: Acute kidney injury (nAKI) is common in neonates with increased mortality and hospitalization. Less is known about the creatinine dynamics outside acute kidney injury and impact on survival in new-borns in the rst week of life. Methods: We performed an observational, retrospective, single-centre study on new-borns admitted to "Louis Turcanu" Emergency County Hospital for Children between 2014 and 2022. The cohort consisted in 1106 neonates with serum creatinine values recorded in the rst day of life and at least another measurement between days 2 and 7. We evaluated the outcomes of ascending serum creatinine trend on mortality, hospital stay and chronic kidney disease development. Results: 23.4% (259) babies had an ascending trend of serum creatinine andhad on day one higher urea levels, lower haemoglobin and thrombocytes, lower serum proteins and higher degrees of in ammation compared to the ones with a descending trend. A rising creatinine increased the risk of nAKI in the rst seven days by 12.93 times and overall nAKI by 4.07 times. Ascending creatinine trend independently increased mortality in the entire cohort by 1.92 times and 4.65 times in the subgroup of patients without AKI. In the crude analysis, ascending creatinine trend increased the risk of chronic kidney disease by 8.74 times and in adjusted model, only nAKI was an independent risk factor (8.57 times). Conclusions: Rising creatinine in the rst week of life independently increased nAKI development and mortality. Even patients with small serum creatinine rises that did not reached nAKI presented higher mortality.