Incidence and outcomes of acute kidney injury in extremely-low-birth-weight infants

• Published in: PloS one Vol. 12; no. 11; p. e0187764
• Main Authors: Lee, Chien-Chung, Chan, Oi-Wa, Lai, Mei-Yin, Hsu, Kai-Hsiang, Wu, Tai-Wei, Lim, Wai-Ho, Wang, Yu-Cheng, Lien, Reyin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.11.2017; Public Library of Science (PLoS)
• Subjects: Acute kidney failure; Acute Kidney Injury - epidemiology; Acute Kidney Injury - pathology; Age; Analysis; Biology and Life Sciences; Birth; Birth weight; Confidence intervals; Congenital diseases; Coronary vessels; Creatinine; Datum (elevation); Gestational age; Health aspects; Hospitals; Humans; Incidence; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - pathology; Infants; Intensive Care Units, Neonatal; Kidney diseases; Kidneys; Low birth weight; Medical prognosis; Medicine; Medicine and Health Sciences; Mortality; Neonates; Nephrology; Newborn babies; Newborn infants; Pediatrics; People and Places; Pre-eclampsia; Preeclampsia; Prevalence studies (Epidemiology); Prognosis; Risk analysis; Risk factors; Rodents; Survival; Ventilation; Ventilators; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0187764

Acute kidney injury (AKI) is a common event in the neonatal intensive care unit (NICU), especially in extremely-low-birth-weight (ELBW) infants. This cohort study investigated the incidence of and risk factors for AKI in ELBW infants and their overall survival at the postmenstrual age (PMA) of 36 weeks. All ELBW infants admitted to our NICU between January 2010 and December 2013 were enrolled. Those who died prior to 72 hours of life, had congenital renal abnormality, or had only one datum of the serum creatinine (SCr) level after the first 24 hours of life were excluded. The criteria used for the diagnosis of AKI was set according to the modified neonatal KDIGO AKI definition. AKI occurred in 56% of 276 infants. Specifically, stage 1, stage 2, and stage 3 AKI occurred in 30%, 17%, and 9% of ELBW infants, respectively. High-frequency ventilation support (adjusted odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.78-6.67, p< 0.001), the presence of patent ductus arteriosus (adjusted OR: 4.3, 95% CI: 2.25-8.07, p < 0.001), lower gestational age (adjusted OR for gestational age: 0.7, 95% CI: 0.58-0.83, < 0.001), and inotropic agent use (adjusted OR: 2.6, 95% CI: 1.31-5.21, p = 0.006) were independently associated with AKI. Maternal pre-eclampsia was a protective factor (adjusted OR: 0.4, 95% CI: 0.14-0.97, p = 0.044). Infants with AKI had higher mortality before the PMA of 36 weeks with an adjusted hazard ratio (HR) of 5.34 (95% CI: 1.21-23.53, p = 0.027). Additionally, infants with stage 3 AKI had a highest HR of 10.60, 95% CI: 2.09-53.67, p = 0.004). AKI was a very common event (56%) in ELBW infants and was associated with a lower GA, high-frequency ventilation support, the presence of PDA, and inotropic agent use. AKI reduced survival of ELBW infants before the PMA of 36 weeks.