Incidence and risk factors of acute kidney injury among the critically ill neonates

Abstract

Acute kidney injury (AKI) is a complex disorder with clinical manifestations ranging from mild dysfunction to complete kidney failure. The published literature on the incidence and outcome of AKI in the critically ill neonatal population is scarce. The aim of this study was to evaluate the types, the associated risk factors and short-term outcome of AKI in the critically ill neonates. A cohort study was conducted including 100 critically ill neonates successively admitted to the Neonatal Intensive Care Unit. The inclusion criteria were a gestational age ≥28 weeks and body weight ≥1 kg. Exclusion criteria included those with multiple congenital anomalies or on drugs altering glomerular filtration rate or AKI developing postoperatively. Neonates were evaluated for the development of AKI [creatinine >1.5 mg/dL and/or blood urea nitrogen (BUN) >20 mg/dL] and were assigned as group A (who developed AKI) and group B (who did not develop AKI). Forty-one patients developed AKI (group A) among whom nine (22%) showed oliguric AKI. The most common risk factors among group A patients were sepsis (75.6%) and nephrotoxic drug administration (75.6%), followed by shock (39%). There were no statistically significant differences between both groups except for male sex predominance and necrotizing enterocolitis (NEC), which were significantly higher among group A (P <0.05). Use of continuous positive airway pressure (CPAP) ventilation was significantly higher in neonates without AKI (13.6% vs 0.0%, P = 0.02). The mortality rate among group A reached 51.2%. Various risk factors including gender, gestational age, birth weight, shock, NEC, sepsis, nephrotoxic drugs, oliguria and mechanical ventilation were studied as regards outcome of group A, and all factors except gender and oliguria proved to be significantly higher in deceased neonates. Male sex and NEC were important risk factors for developing AKI that was predominantly non-oliguric. CPAP ventilation may have a protective effect against AKI. The mortality rate was more than three times higher in the AKI group.

Prediction of risk factors and outcomes of neonatal acute kidney injury

“…These results are consistent with a study published by Shalaby et al [ 13 ], which concurred that the overall mortality rate was 28.3% and that neonatal AKI was significantly associated with mortality but not with the length of hospital stay. A similar finding has been noted by Criss et al [ 18 ], who reported that mortality rates among neonates with AKI were 35.9%. They further surmised that neonates with AKI had higher mortality and a greater chance of death, but the effect of LOS on survivors did not reach statistical significance, which agreed with our results.…”

Risk Factors for Acute Kidney Injury in Critically Ill Neonates: A Systematic Review and Meta-Analysis

“…Nowadays, the diagnosis of neonatal AKI has not been unified. There are five definitions that describe the state of neonatal AKI in our meta-analysis: (1) arbitrary definition mainly based on absolute serum creatinine (SCr) ≥1.5 mg/dl;( 4 , 23 , 24 , 27 ), (2) arbitrary definition based on absolute SCr >1 mg/dl and >1.3 mg/dl (for ≥33 weeks and <33 weeks, respectively) after 48 h of life;( 12 , 22 ), (3) AKIN definition based on absolute SCr ≥ 0.3mg/dl or SCr ≥1.5 times baseline within 48 h or urine volume <0.5 ml/kg/h for 6 h;( 11 , 21 , 25 ), (4) KDIGO definition based on absolute SCr ≥0.3 mg/dl within 48 h or SCr ≥1.5 times baseline, which is known or presumed within 7 days, or urine volume <0.5 ml/kg/h for 6 h;( 1 , 6 , 29 ), and (5) modified KDIGO definition changes the baseline to previous trough value in SCr ( 2 , 5 , 20 , 26 , 28 , 30 , 31 , 45 ). As we can see, the arbitrary definitions are mainly dependent on an absolute increase in SCr for at least 1 mg/dl, whose critical value is higher than that of AKIN and KDIGO.…”

Differences in the Clinical Characteristics of Early- and Late-Onset Necrotizing Enterocolitis in Full-Term Infants: A Retrospective Case-Control Study

“…Respiratory failure and peritonitis have been reported as risk factors for poor prognosis in previous studies 10 26 28 . Kidney failure, one of the most severe complications of NEC 30 , was first identified as a risk factor for NEC mortality in a pilot study (n = 19) conducted by Rivera-Moreno in 1999 31 . The findings of the present study further demonstrated the association between kidney failure and mortality, and further studies should be conducted to clarify the molecular mechanism underlying this association.…”