Faculty Collaboration Database

Perinatal risk factors associated with acute kidney injury severity and duration among infants born extremely preterm. Pediatr Res 2024 Aug;96(3):740-749

Date

03/05/2024

Pubmed ID

38438550

Pubmed Central ID

PMC11371939

DOI

10.1038/s41390-024-03102-w

Scopus ID

2-s2.0-85186602995 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: We evaluated time-varying perinatal risk factors associated with early (≤7 post-natal days) and late (>7 post-natal days) severe acute kidney injury (AKI) occurrence and duration.

METHODS: A secondary analysis of Preterm Erythropoietin Neuroprotection Trial data. We defined severe AKI (stage 2 or 3) per neonatal modified Kidney Disease: Improving Global Outcomes criteria. Adjusted Cox proportional hazards models were conducted with exposures occurring at least 72 h before severe AKI. Adjusted negative binomial regression models were completed to evaluate risk factors for severe AKI duration.

RESULTS: Of 923 participants, 2% had early severe AKI. In the adjusted model, gestational diabetes (adjusted HR (aHR) 5.4, 95% CI 1.1-25.8), non-steroidal anti-inflammatory drugs (NSAIDs) (aHR 3.2, 95% CI 1.0-9.8), and vancomycin (aHR 13.9, 95% CI 2.3-45.1) were associated with early severe AKI. Late severe AKI occurred in 22% of participants. Early severe AKI (aHR 2.5, 95% CI 1.1-5.4), sepsis (aHR 2.5, 95% CI 1.4-4.4), vasopressors (aHR 2.9, 95% CI 1.8-4.6), and diuretics (aHR 2.6, 95% CI 1.9-3.6) were associated with late severe AKI. Participants who had necrotizing enterocolitis or received NSAIDs had longer severe AKI duration.

CONCLUSION: We identified major risk factors for severe AKI that can be the focus of future research.

IMPACT STATEMENT: Time-dependent risk factors for severe acute kidney injury (AKI) and its duration are not well defined among infants born <28 weeks' gestation. Over 1 in 5 infants born <28 weeks' gestation experienced severe AKI, and this study identified several major time-dependent perinatal risk factors occurring within 72 h prior to severe AKI. This study can support efforts to develop risk stratification and clinical decision support to help mitigate modifiable risk factors to reduce severe AKI occurrence and duration.

Author List

Sanderson K, Griffin R, Anderson N, South AM, Swanson JR, Zappitelli M, Steflik HJ, DeFreitas MJ, Charlton J, Askenazi D, Neonatal Kidney Collaborative (NKC) Research Committee

Author

Jeffrey L. Segar MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Anti-Inflammatory Agents, Non-Steroidal
Diabetes, Gestational
Female
Gestational Age
Humans
Infant, Extremely Premature
Infant, Newborn
Male
Pregnancy
Proportional Hazards Models
Risk Factors
Sepsis
Severity of Illness Index
Time Factors
Vancomycin