Skip to main content

Advertisement

SpringerLink
Log in

Acute changes in fluid status affect the incidence, associative clinical outcomes, and urine biomarker performance in premature infants with acute kidney injury

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

During the first postnatal weeks, infants have abrupt changes in fluid weight that alter serum creatinine (SCr) concentration, and possibly, the evaluation for acute kidney injury (AKI).

Methods

We performed a prospective study on 122 premature infants to determine how fluid adjustment (FA) to SCr alters the incidence of AKI, demographics, outcomes, and performance of candidate urine biomarkers. FA-SCr values were estimated using changes in total body water (TBW) from birth; FA-SCR = SCr × [TBW + (current wt. – BW)]/ TBW; where TBW = 0.8 × wt in kg). SCr-AKI and FA-SCr AKI were defined if values increased by ≥ 0.3 mg/dl from previous lowest value.

Results

AKI incidence was lower using the FA-SCr vs. SCr definition [(23/122 (18.8 %) vs. (34/122 (27.9 %); p < 0.05)], with concordance in 105/122 (86 %) and discordance in 17/122 (14 %). Discordant subjects tended to have similar demographics and outcomes to those who were negative by both definitions. Candidate urine AKI biomarkers performed better under the FA-SCr than SCr definition, especially on day 4 and days 12–14.

Conclusions

Adjusting SCr for acute change in fluid weight may help differentiate SCr rise from true change in renal function from acute concentration due to abrupt weight change.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Patel RM, Kandefer S, Walsh MC, Bell EF, Carlo WA, Laptook AR, Sanchez PJ, Shankaran S, Van Meurs KP, Ball MB, Hale EC, Newman NS, Das A, Higgins RD, Stoll BJ, Eunice Kennedy Shriver National Institute of Child H, Human Development Neonatal Research N (2015) Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 372:331–340

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR (2009) Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53:961–973

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chawla LS, Eggers PW, Star RA, Kimmel PL (2014) Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 371:58–66

    Article  PubMed  Google Scholar 

  4. Askenazi DJ, Griffin R, McGwin G, Carlo W, Ambalavanan N (2009) Acute kidney injury is independently associated with mortality in very low birthweight infants: a matched case–control analysis. Pediatr Nephrol 24:991–997

    Article  PubMed  Google Scholar 

  5. Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D (2011) Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res 69:354–358

    Article  PubMed  Google Scholar 

  6. Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N (2013) Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol 28:661–666

    Article  PubMed  Google Scholar 

  7. Gadepalli SK, Selewski DT, Drongowski RA, Mychaliska GB (2011) Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem. J Pediatr Surg 46:630–635

    Article  PubMed  Google Scholar 

  8. Kaur S, Jain S, Saha A, Chawla D, Parmar VR, Basu S, Kaur J (2011) Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr 31:129–134

    Article  CAS  PubMed  Google Scholar 

  9. Alabbas A, Campbell A, Skippen P, Human D, Matsell D, Mammen C (2013) Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol 28:1127–1134

    Article  PubMed  Google Scholar 

  10. Selewski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar S (2013) Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr 162:725–729, e1

    Article  PubMed  Google Scholar 

  11. Zwiers AJ, de Wildt SN, Hop WC, Dorresteijn EM, Gischler SJ, Tibboel D, Cransberg K (2013) Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation: a 14-year cohort study. Crit Care 17:R151

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rhone ET, Carmody JB, Swanson JR, Charlton JR (2014) Nephrotoxic medication exposure in very low birth weight infants. J Matern Fetal Neonatal Med 27:1485–1490

    Article  CAS  PubMed  Google Scholar 

  13. Morgan CJ, Zappitelli M, Robertson CM, Alton GY, Sauve RS, Joffe AR, Ross DB, Rebeyka IM (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162:120–127, e1

    Article  PubMed  Google Scholar 

  14. Carmody JB, Swanson JR, Rhone ET, Charlton JR (2014) Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol 9:2036–2043

    Article  PubMed  PubMed Central  Google Scholar 

  15. Khwaja A (2012) KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clin Pract 120:c179–c184

    Article  PubMed  Google Scholar 

  16. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31

    Article  PubMed  PubMed Central  Google Scholar 

  17. Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM (2005) The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis 46:1038–1048

    Article  PubMed  Google Scholar 

  18. Jetton JG, Askenazi DJ (2012) Update on acute kidney injury in the neonate. Curr Opin Pediatr 24:191–196

    Article  CAS  PubMed  Google Scholar 

  19. Oh W, Poindexter BB, Perritt R, Lemons JA, Bauer CR, Ehrenkranz RA, Stoll BJ, Poole K, Wright LL (2005) Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr 147:786–790

    Article  PubMed  Google Scholar 

  20. Bell EF, Acarregui MJ (2014) Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 12:CD000503

    PubMed  Google Scholar 

  21. Basu RK, Andrews A, Krawczeski C, Manning P, Wheeler DS, Goldstein SL (2013) Acute kidney injury based on corrected serum creatinine is associated with increased morbidity in children following the arterial switch operation. Pediatr Crit Care Med 14:e218–e224

    Article  PubMed  Google Scholar 

  22. Liu KD, Thompson BT, Ancukiewicz M, Steingrub JS, Douglas IS, Matthay MA, Wright P, Peterson MW, Rock P, Hyzy RC, Anzueto A, Truwit JD (2011) Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes. Crit Care Med 39:2665–2671

    Article  PubMed  PubMed Central  Google Scholar 

  23. Thongprayoon C, Cheungpasitporn W, Srivali N, Ungprasert P, Kittanamongkolchai W, Kashani K (2015) The impact of fluid balance on diagnosis, staging and prediction of mortality in critically ill patients with acute kidney injury. J Nephrol. doi:10.1007/s40620-015-0211-3

    PubMed  Google Scholar 

  24. Anderson HL 3rd, Coran AG, Drongowski RA, Ha HJ, Bartlett RH (1992) Extracellular fluid and total body water changes in neonates undergoing extracorporeal membrane oxygenation. J Pediatr Surg 27:1003–1007

    Article  PubMed  Google Scholar 

  25. Hartnoll G, Betremieux P, Modi N (2000) Randomised controlled trial of postnatal sodium supplementation on body composition in 25 to 30 week gestational age infants. Arch Dis Child Fetal Neonatal Ed 82:F24–28

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Jobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med 13:1723–1729

    Article  Google Scholar 

  27. Shima Y, Kumasaka S, Migita M (2013) Perinatal risk factors for adverse long-term pulmonary outcome in premature infants: comparison of different definitions of bronchopulmonary dysplasia/chronic lung disease. Pediatr Int 55:578–581

    Article  PubMed  Google Scholar 

  28. Groothuis JR, Makari D (2012) Definition and outpatient management of the very low-birth-weight infant with bronchopulmonary dysplasia. Adv Ther 29:297–311

    Article  PubMed  Google Scholar 

  29. Natarajan G, Pappas A, Shankaran S, Kendrick DE, Das A, Higgins RD, Laptook AR, Bell EF, Stoll BJ, Newman N, Hale EC, Bara R, Walsh MC (2012) Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Hum Dev 88:509–515

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kim SM, Lee EY, Chen J, Ringer SA (2010) Improved care and growth outcomes by using hybrid humidified incubators in very preterm infants. Pediatrics 125:e137–e145

    Article  PubMed  Google Scholar 

  31. Saeidi B, Koralkar R, Griffin RL, Halloran B, Ambalavanan N, Askenazi DJ (2015) Impact of gestational age, sex, and postnatal age on urine biomarkers in premature neonates. Pediatr Nephrol 30:2037–2044

    Article  PubMed  Google Scholar 

  32. Askenazi DJ, Koralkar R, Levitan EB, Goldstein SL, Devarajan P, Khandrika S, Mehta RL, Ambalavanan N (2011) Baseline values of candidate urine acute kidney injury biomarkers vary by gestational age in premature infants. Pediatr Res 70:302–306

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave S, Lowder 516, Birmingham, AL, 35233, USA

    David Askenazi, Behtash Saeidi & Rajesh Koralkar

  2. Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    Namasivayam Ambalavanan

  3. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Russell L. Griffin

Authors
  1. David Askenazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Behtash Saeidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajesh Koralkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Namasivayam Ambalavanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Russell L. Griffin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Askenazi.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at the University of Alabama at Birmingham, as well all with the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed parental consent was obtained for all individual participants included in the study.

Statement of financial support

Research reported in this publication was supported by the Norman Siegel Career Development Award from the American Society of Nephrology. Dr. Askenazi receives funding from the NIH (R01 DK13608-01) and the Pediatric and Infant Center for Acute Nephrology (PICAN), which is sponsored by Children’s of Alabama and the University of Alabama at Birmingham’s School of Medicine, Department of Pediatrics and Center for Clinical and Translational Science (CCTS) under award number UL1TR00165. Dr. Ambalavanan receives funding from NIH (grant # U01 HL122626; R01 HD067126; R01 HD066982; U10 HD34216). Dr. Griffin receives funding from UAB CCTS, and PICAN.

Conflict of interest

Dr. Askenazi is a speaker for The Acute Kidney Injury Foundation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Askenazi, D., Saeidi, B., Koralkar, R. et al. Acute changes in fluid status affect the incidence, associative clinical outcomes, and urine biomarker performance in premature infants with acute kidney injury. Pediatr Nephrol 31, 843–851 (2016). https://doi.org/10.1007/s00467-015-3258-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-015-3258-4

Keywords

Search

Navigation