Strategies to improve the understanding of long-term renal consequences after neonatal acute kidney injury

Askenazi, David; Morgan, Catherine; Goldstein, Stuart L.; Selewski, David T.; Moxey-Mims, Marva; Kimmel, Paul L.; Star, Robert A.; Higgins, Rosemary D.; Laughon, Matthew M.

doi:10.1038/pr.2015.241

Cited by 26 publications

(23 citation statements)

References 41 publications

(39 reference statements)

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“…AKI occurs in 16-70% of preterm infants [136,137], 40% of neonates with severe perinatal asphyxia, and 60% of newborns who undergo cardiopulmonary bypass for congenital heart disease [138]. AKI is an important risk factor for death in neonates [136,138].…”

Section: Consensus Recommendationsmentioning

confidence: 99%

“…AKI is an important risk factor for death in neonates [136,138]. The risk factors for AKI include lower gestational age and birth weight, SGA, renal hypoperfusion, nephrotoxin exposure, sepsis, obstruction, and renal arterial or venous thrombosis [142,159].…”

Section: Consensus Recommendationsmentioning

confidence: 99%

“…AKI occurs in 16-70% of neonatal populations [136,137,138]. Some of this variability comes from reports of neonates and preterm infants with varying comorbidities (e.g., congenital diaphragmatic hernia, cardiac surgery, and asphyxia) but also reflects the challenge of diagnosing AKI in the neonate and the lack, until recently, of a uniform diagnostic classification [136].…”

Section: Introduction To a Health Problemmentioning

confidence: 99%

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The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Brenner

Charlton

Luyckx

et al. 2017

Nephron

119

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Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.

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Section: Consensus Recommendationsmentioning

confidence: 99%

Section: Consensus Recommendationsmentioning

confidence: 99%

Section: Introduction To a Health Problemmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Brenner

Charlton

Luyckx

et al. 2017

Nephron

119

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“…Critical to advancing the field of neonatal AKI is collaborative research among neonatologists and pediatric nephrologists. To foster this partnership, the National Institutes of Health (NIH) sponsored a multidisciplinary workshop on neonatal AKI in April 2013 ( 16 , 17 ). Soon after, the Neonatal Kidney Collaborative (NKC) was formed to address the critical gaps in knowledge highlighted at the workshop.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study

et al. 2016

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IntroductionAcute kidney injury (AKI) affects ~30% of hospitalized neonates. Critical to advancing our understanding of neonatal AKI is collaborative research among neonatologists and nephrologists. The Neonatal Kidney Collaborative (NKC) is an international, multidisciplinary group dedicated to investigating neonatal AKI. The AWAKEN study (Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates) was designed to describe the epidemiology of neonatal AKI, validate the definition of neonatal AKI, identify primary risk factors for neonatal AKI, and investigate the contribution of fluid management to AKI events and short-term outcomes.Methods and analysisThe NKC was established with at least one pediatric nephrologist and neonatologist from 24 institutions in 4 countries (USA, Canada, Australia, and India). A Steering Committee and four subcommittees were created. The database subcommittee oversaw the development of the web-based database (MediData Rave™) that captured all NICU admissions from 1/1/14 to 3/31/14. Inclusion and exclusion criteria were applied to eliminate neonates with a low likelihood of AKI. Data collection included: (1) baseline demographic information; (2) daily physiologic parameters and care received during the first week of life; (3) weekly “snapshots”; (4) discharge information including growth parameters, final diagnoses, discharge medications, and need for renal replacement therapy; and (5) all serum creatinine values.Ethics and disseminationAWAKEN was proposed as human subjects research. The study design allowed for a waiver of informed consent/parental permission. NKC investigators will disseminate data through peer-reviewed publications and educational conferences.DiscussionThe purpose of this publication is to describe the formation of the NKC, the establishment of the AWAKEN cohort and database, future directions, and a few “lessons learned.” The AWAKEN database includes ~325 unique variables and >4 million discrete data points. AWAKEN will be the largest, most inclusive neonatal AKI study to date. In addition to validating the neonatal AKI definition and identifying risk factors for AKI, this study will uncover variations in practice patterns related to fluid provision, renal function monitoring, and involvement of pediatric nephrologists during hospitalization. The AWAKEN study will position the NKC to achieve the long-term goal of improving the lives, health, and well-being of newborns at risk for kidney disease.

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“…It is unclear whether pediatric AKI definitions (7) are applicable to neonates, leading to inconsistency in defining neonatal AKI within the literature and significant lags in AKI research. In 2013, an NIDDK-sponsored workshop with neonatologists, pediatric nephrologists, and NIH representatives was conducted (8), including an AKI definition workshop. This report summarizes this discussion, and aimed toward the following: (i) identify challenges and potential solutions to neonatal AKI definition; (ii) evaluate current AKI definitions; and (iii) provide recommendations for the development of a neonatal AKI definition.…”

mentioning

confidence: 99%

Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop

et al. 2017

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Disclosure: The authors declare no conflict of interest. 1. Research is needed to focus on evaluating the validity and outcome associations of different methods of defining baseline SCr in neonates, which consider the physiological changes occurring in SCr in early neonatal life 2. Research is needed to develop SCr-based neonatal AKI definitions by studying newborn infants at varying gestational and postnatal ages, from the first few weeks of life, compared with older age groups 3. Studies evaluating neonatal AKI and long-term outcomes should be powered to evaluate the association between at least stage 2 AKI and outcomes Use of urine output change as a criterion for defining AKI in newborn infants 4. Research is needed to further evaluate urine output-defined AKI in neonatal AKI studies, including comparison with SCr-AKI definition and outcome associations 5. Research is needed to define "volume overload" or "change in volume status/balance" by evaluating and comparing studies that precisely measured urine output and incorporating the findings in the definition of neonatal AKI 6. Urine output and/or volume overload-based neonatal AKI definitions need to be evaluated in neonates of varying gestational and postnatal ages, comparing the first week of life with later periods Use of other serum and urine biomarkers for a neonatal AKI definition 7. Future studies need to evaluate novel AKI biomarkers in neonates for AKI diagnosis and prediction of short-and long-term neonatal outcomes 8. Studies are needed to elucidate neonatal clinical and physiologic factors that affect AKI biomarker concentrations independent of renal function

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Strategies to improve the understanding of long-term renal consequences after neonatal acute kidney injury

Cited by 26 publications

References 41 publications

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study

Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop

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