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Pediatric Nephrology

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01-09-2018 | Original Article

Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study

Authors: Mohamed A. Shalaby, Zinab A. Sawan, Esraa Nawawi, Saad Alsaedi, Heidi Al-Wassia, Jameela A. Kari

Published in: Pediatric Nephrology | Issue 9/2018

Abstract

Background

Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease.

Objectives

To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU.

Methods

This single-center prospective cohort study included all infants who received level II or III NICU care during 2015 (January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence interval (95% CI).

Results

The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32 ± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3–9) and perinatal depression (RR, 10; 95% CI, 2–46) were significantly associated with an increased risk of AKI. For infants with gestational age < 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95% CI, 1–3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2–14), but not with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference: 14 days; 95% CI, 5.5–23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels (> 65 μmol/L).

Conclusion

AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after discharge is warranted in such infants.

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Title: Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study
Authors: Mohamed A. Shalaby
Zinab A. Sawan
Esraa Nawawi
Saad Alsaedi
Heidi Al-Wassia
Jameela A. Kari
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 9/2018
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-018-3966-7

2024 ASCO Annual Meeting

Springer Medicine

Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study

Abstract

Background

Objectives

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusion

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