TY - JOUR
T1 - Perinatal risk factors associated with acute kidney injury severity and duration among infants born extremely preterm
AU - Sanderson, Keia
AU - Griffin, Russell
AU - Anderson, Nekayla
AU - South, Andrew M.
AU - Swanson, Jonathan R.
AU - Zappitelli, Michael
AU - Steflik, Heidi J.
AU - DeFreitas, Marissa J.
AU - Charlton, Jennifer
AU - Askenazi, David
AU - Fuloria, Mamta
AU - Hanna, Mina
AU - Harer, Matthew W.
AU - Slagle, Cara
AU - Schuh, Meredith P.
AU - Woroniecki, Robert
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc 2024.
PY - 2024
Y1 - 2024
N2 - Background: We evaluated time-varying perinatal risk factors associated with early (≤7 post-natal days) and late (>7 post-natal days) severe acute kidney injury (AKI) occurrence and duration. Methods: A secondary analysis of Preterm Erythropoietin Neuroprotection Trial data. We defined severe AKI (stage 2 or 3) per neonatal modified Kidney Disease: Improving Global Outcomes criteria. Adjusted Cox proportional hazards models were conducted with exposures occurring at least 72 h before severe AKI. Adjusted negative binomial regression models were completed to evaluate risk factors for severe AKI duration. Results: Of 923 participants, 2% had early severe AKI. In the adjusted model, gestational diabetes (adjusted HR (aHR) 5.4, 95% CI 1.1–25.8), non-steroidal anti-inflammatory drugs (NSAIDs) (aHR 3.2, 95% CI 1.0–9.8), and vancomycin (aHR 13.9, 95% CI 2.3–45.1) were associated with early severe AKI. Late severe AKI occurred in 22% of participants. Early severe AKI (aHR 2.5, 95% CI 1.1–5.4), sepsis (aHR 2.5, 95% CI 1.4–4.4), vasopressors (aHR 2.9, 95% CI 1.8–4.6), and diuretics (aHR 2.6, 95% CI 1.9–3.6) were associated with late severe AKI. Participants who had necrotizing enterocolitis or received NSAIDs had longer severe AKI duration. Conclusion: We identified major risk factors for severe AKI that can be the focus of future research. Impact statement: Time-dependent risk factors for severe acute kidney injury (AKI) and its duration are not well defined among infants born <28 weeks’ gestation. Over 1 in 5 infants born <28 weeks’ gestation experienced severe AKI, and this study identified several major time-dependent perinatal risk factors occurring within 72 h prior to severe AKI. This study can support efforts to develop risk stratification and clinical decision support to help mitigate modifiable risk factors to reduce severe AKI occurrence and duration.
AB - Background: We evaluated time-varying perinatal risk factors associated with early (≤7 post-natal days) and late (>7 post-natal days) severe acute kidney injury (AKI) occurrence and duration. Methods: A secondary analysis of Preterm Erythropoietin Neuroprotection Trial data. We defined severe AKI (stage 2 or 3) per neonatal modified Kidney Disease: Improving Global Outcomes criteria. Adjusted Cox proportional hazards models were conducted with exposures occurring at least 72 h before severe AKI. Adjusted negative binomial regression models were completed to evaluate risk factors for severe AKI duration. Results: Of 923 participants, 2% had early severe AKI. In the adjusted model, gestational diabetes (adjusted HR (aHR) 5.4, 95% CI 1.1–25.8), non-steroidal anti-inflammatory drugs (NSAIDs) (aHR 3.2, 95% CI 1.0–9.8), and vancomycin (aHR 13.9, 95% CI 2.3–45.1) were associated with early severe AKI. Late severe AKI occurred in 22% of participants. Early severe AKI (aHR 2.5, 95% CI 1.1–5.4), sepsis (aHR 2.5, 95% CI 1.4–4.4), vasopressors (aHR 2.9, 95% CI 1.8–4.6), and diuretics (aHR 2.6, 95% CI 1.9–3.6) were associated with late severe AKI. Participants who had necrotizing enterocolitis or received NSAIDs had longer severe AKI duration. Conclusion: We identified major risk factors for severe AKI that can be the focus of future research. Impact statement: Time-dependent risk factors for severe acute kidney injury (AKI) and its duration are not well defined among infants born <28 weeks’ gestation. Over 1 in 5 infants born <28 weeks’ gestation experienced severe AKI, and this study identified several major time-dependent perinatal risk factors occurring within 72 h prior to severe AKI. This study can support efforts to develop risk stratification and clinical decision support to help mitigate modifiable risk factors to reduce severe AKI occurrence and duration.
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U2 - 10.1038/s41390-024-03102-w
DO - 10.1038/s41390-024-03102-w
M3 - Article
AN - SCOPUS:85186602995
SN - 0031-3998
JO - Pediatric Research
JF - Pediatric Research
ER -