Acute Kidney Injury in Very Low Birth Weight Infants: A Major Morbidity and Mortality Risk Factor

Abstract

Background and objectives: Very low birth weight (VLBW) infants are at high risk of developing acute kidney injury (AKI), presumably secondary to low kidney reserves, stressful postnatal events, and drug exposures. Our study aimed to identify the prevalence, risk factors, and outcomes associated with AKI in VLBW infants. Study design: Records of all VLBW infants admitted to two medical campuses between January 2019 and June 2020 were retrospectively reviewed. AKI was classified using the modified KDIGO definition to include only serum creatinine. Risk factors and composite outcomes were compared between infants with and without AKI. We evaluated the main predictors of AKI and death with forward stepwise regression analysis. Results: 152 VLBW infants were enrolled. 21% of them developed AKI. Based on the multivariable analysis, the most significant predictors of AKI were the use of vasopressors, patent ductus arteriosus, and bloodstream infection. AKI had a strong and independent association with neonatal mortality. Conclusions: AKI is common in VLBW infants and is a significant risk factor for mortality. Efforts to prevent AKI are necessary to prevent its harmful effects.

Incidence, Risk Factors, and Outcomes Associated With Recurrent Neonatal Acute Kidney Injury in the AWAKEN Study

“…As the effect of AKI becomes clearer in critically ill neonates, 1,4,5,7,8 it is important to better understand high-risk states such as rAKI, which has been understudied. To our knowledge, this secondary analysis of the AWAKEN study is the first multicenter analysis of the incidence, risk factors, and outcomes associated with rAKI in a broad cohort of critically ill neonates.…”

“…Acute kidney injury (AKI) occurs commonly in critically ill neonates and is independently associated with adverse outcomes, including longer length of hospital stay (LOS) and increased mortality. [1][2][3][4][5][6][7][8][9][10] Acute kidney injury may predispose neonates to subsequent kidney injury, and survivors of neonatal AKI are potentially at risk for long-term complications, including chronic kidney disease. 11,12 As our understanding of the incidence and impact of neonatal AKI becomes clearer, it is important to better understand the incidence and outcomes associated with the occurrence of more than 1 episode of neonatal AKI after resolution of a previous AKI episode during the same hospitalization, or recurrent AKI (rAKI).…”

“…Acute kidney injury (AKI) occurs commonly in critically ill neonates and is independently associated with adverse outcomes, including longer length of hospital stay (LOS) and increased mortality . Acute kidney injury may predispose neonates to subsequent kidney injury, and survivors of neonatal AKI are potentially at risk for long-term complications, including chronic kidney disease .…”

Editorial on the Special Issue “Advances in Pediatric Acute Kidney Injury”

“…For example, very-low-birth-weight babies are at an increased risk due to insufficient renal reserves, stressful postnatal events, and medication exposures [26]. Lazarovits et al reported a 21% prevalence of AKI in 152 infants with very low birth weight, with predictors including the use of vasopressors, patent ductus arteriosus, and bloodstream infection [26]. Neonatal mortality and AKI were strongly correlated [26].…”

“…Lazarovits et al reported a 21% prevalence of AKI in 152 infants with very low birth weight, with predictors including the use of vasopressors, patent ductus arteriosus, and bloodstream infection [26]. Neonatal mortality and AKI were strongly correlated [26]. Various methods exist to diagnose AKI [9,27], such as the widely used risk, injury, failure, loss, and end-stage (RIFLE) criteria [28].…”