Assessing the prognostic impact of KDIGO criteria on acute kidney injury in very low birth weight infants: a critical insight
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Purpose: To evaluate the incidence and identify risk factors for acute kidney injury (AKI) within the first 15 days of life in very low birth weight (VLBW) infants in a neonatal intensive care unit. Additionally, this study will examine whether AKI correlates with increased mortality rate in this population.Methods: A prospective analysis was conducted on VLBW infants admitted to the neonatal intensive care unit from March 2017 to July 2021, diagnosing AKI based on the neonatal modified Kidney Disease: Improving Global Outcomes criteria. Neonates who died before obtaining consent, had complex malformation, or only one serum creatinine measurement were excluded.Results: Out of 121 admitted VLBW infants, 97 were analyzed, with 20 (20.6%; 95% confidence interval, 12.6–28.7) diagnosed with AKI. Among these, 50% had creatinine abnormalities, 30% had urinary output changes, and 20% had both. Severe AKI (stage 2 or 3) was observed in 30% of cases, none required dialysis. AKI was associated with higher SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension-II) scores, more frequent severe intraventricular hemorrhage, and an increased mortality rate (35%). Multivariate analysis identified AKI as an independent risk factor for mortality, with a 9.72-fold increased risk (95% confidence interval, 2.53–37.4; <i>P</i><0.01), and a shorter time to death.Conclusions: Our findings underscore a significant incidence of AKI among VLBW infants, along with its strong association with increased mortality. These results highlight the critical need for thorough assessment of both serum creatinine and urinary output when diagnosing AKI in this vulnerable population.
Abstract
Purpose: To evaluate the incidence and identify risk factors for acute kidney injury (AKI) within the first 15 days of life in very low birth weight (VLBW) infants in a neonatal intensive care unit. Additionally, this study will examine whether AKI correlates with increased mortality rate in this population.Methods: A prospective analysis was conducted on VLBW infants admitted to the neonatal intensive care unit from March 2017 to July 2021, diagnosing AKI based on the neonatal modified Kidney Disease: Improving Global Outcomes criteria. Neonates who died before obtaining consent, had complex malformation, or only one serum creatinine measurement were excluded.Results: Out of 121 admitted VLBW infants, 97 were analyzed, with 20 (20.6%; 95% confidence interval, 12.6–28.7) diagnosed with AKI. Among these, 50% had creatinine abnormalities, 30% had urinary output changes, and 20% had both. Severe AKI (stage 2 or 3) was observed in 30% of cases, none required dialysis. AKI was associated with higher SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension-II) scores, more frequent severe intraventricular hemorrhage, and an increased mortality rate (35%). Multivariate analysis identified AKI as an independent risk factor for mortality, with a 9.72-fold increased risk (95% confidence interval, 2.53–37.4; <i>P</i><0.01), and a shorter time to death.Conclusions: Our findings underscore a significant incidence of AKI among VLBW infants, along with its strong association with increased mortality. These results highlight the critical need for thorough assessment of both serum creatinine and urinary output when diagnosing AKI in this vulnerable population.
참고문헌 (22)
- Mercier K, "Preterm neonatal urinary renal developmental and acute kidney injury metabolomic profiling : an exploratory study", Pediatr Nephrol, 32, pp.151~161 (2017)
- Jetton JG, "Incidence and outcomes of neonatal acute kidney injury(AWAKEN) : a multicentre, multinational, observational cohort study", Lancet Child Adolesc Health, 1, pp.184~194 (2017)
- Askenazi DJ, "Prevalence of acute kidney injury(AKI)in extremely low gestational age neonates(ELGAN)", Pediatr Nephrol, 35, pp.1737~1748 (2020)
- Jetton JG, "Assessment of worldwide acute kidney injury epidemiology in neonates : design of a retrospective cohort study", Front Pediatr, 4, pp.68~ (2016)
- Section 2, "AKI definition", Kidney Int Suppl(2011), 2, pp.19~36 (2012)
- Zappitelli M, "The long and the short of it : the impact of acute kidney injury in critically ill children", J Pediatr(Rio J), 96, pp.533~536 (2020)
- Selewski DT, "Neonatal acute kidney injury", Pediatrics, 136, pp.e463~73 (2015)
- Sutherland SM, "Epidemiology of acute kidney injury in children : a report from the 26th Acute Disease Quality Initiative(ADQI)consensus conference", Pediatr Nephrol, 39, pp.919~928 (2024)
- Mammen C, "Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit : a prospective cohort study", Am J Kidney Dis, 59, pp.523~530 (2012)
- Goldstein SL, "Consensus-based recommendations on priority activities to address acute kidney injury in children : a modified Delphi consensus statement", JAMA Netw Open, 5, pp.e2229442~ (2022)
- Zappitelli M, "Developing a neonatal acute kidney injury research definition : a report from the NIDDK neonatal AKI workshop", Pediatr Res, 82, pp.569~573 (2017)
- Richardson DK, "SNAP-II and SNAPPE-II : simplified newborn illness severity and mortality risk scores", J Pediatr, 138, pp.92~100 (2001)
- Muktan D, "Neonatal mortality risk assessment using SNAPPE-II score in a neonatal intensive care unit", BMC Pediatr, 19, pp.279~ (2019)
- Burgmaier K, "Low incidence of acute kidney injury in VLBW infants with restrictive use of mechanical ventilation", Pediatr Nephrol, 39, pp.1279~1288 (2024)
- Daga A, "Diagnosis and risk factors of acute kidney injury in very low birth weight infants", Pediatr Neonatol, 58, pp.258~263 (2017)
- Srinivasan N, "Acute kidney injury impairs postnatal renal adaptation and increases morbidity and mortality in very low-birth-weight infants", Am J Perinatol, 35, pp.39~47 (2018)
- Kaddourah A, "Epidemiology of acute kidney injury in critically ill children and young adults", N Engl J Med, 376, pp.11~20 (2017)
- Harer MW, "Association between early caffeine citrate administration and risk of acute kidney injury in preterm neonates : results from the AWAKEN Study", JAMA Pediatr, 172, pp.e180322~ (2018)
- Haynes N, "Receipt of high-frequency ventilation is associated with acute kidney injury in very preterm neonates", Pediatr Nephrol, 39, pp.579~587 (2024)
- Turker G, "Acute renal failure SNAPPE and mortality", Pediatr Int, 53, pp.483~488 (2011)
- Askenazi D, "Acute kidney injury is associated with bronchopulmonary dysplasia", mortality in premature infants, 2015, pp.30, 1511~1518
- Wu Y, "Acute kidney injury in premature and low birth weight neonates : a systematic review and meta-analysis", Pediatr Nephrol, 37, pp.275~287 (2022)