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Acute kidney injury in neonates with hypoxic ischemic encephalopathy based on serum creatinine decline compared to KDIGO criteria

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Abstract

Background

Neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia (HIE + TH) are at risk for acute kidney injury (AKI). The standardized Kidney Disease Improving Global Outcomes (KDIGO) criteria identifies AKI based on a rise in serum creatinine (SCr) or reduced urine output. This definition is challenging to apply in neonates given the physiologic decline in SCr during the first week of life. Gupta et al. proposed alternative neonatal criteria centered on rate of SCr decline. This study aimed to compare the rate of AKI based on KDIGO and Gupta in neonates with HIE and to examine associations with mortality and morbidity.

Methods

A retrospective review was performed of neonates with moderate to severe HIE + TH from 2008 to 2020 at a single center. AKI was assessed in the first 7 days after birth by KDIGO and Gupta criteria. Mortality, brain MRI severity of injury, length of stay, and duration of respiratory support were compared between AKI groups.

Results

Among 225 neonates, 64 (28%) met KDIGO, 69 (31%) neonates met Gupta but not KDIGO, and 92 (41%) did not meet either definition. Both KDIGO-AKI and GuptaOnly-AKI groups had an increased risk of the composite mortality and/or moderate/severe brain MRI injury along with longer length of stay and prolonged duration of respiratory support compared to those without AKI.

Conclusions

AKI in neonates with HIE + TH was common and varied by definition. The Gupta definition based on rate of SCr decline identified additional neonates not captured by KDIGO criteria who are at increased risk for adverse outcomes. Incorporating the rate of SCr decline into the neonatal AKI definition may increase identification of clinically relevant kidney injury in neonates with HIE + TH.

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Funding

This work was supported by the Stanford Maternal and Child Health Research Institute Clinical Trainee Grant.

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Author notes

  1. Haejun C. Ahn

    Present address: Pediatric Nephrology, Swedish Health, Seattle, WA, USA

Authors and Affiliations

  1. Division of Pediatric Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA

    Haejun C. Ahn & Scott M. Sutherland

  2. Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    Adam Frymoyer, Sonia Bonifacio & Valerie Y. Chock

  3. Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA

    Derek B. Boothroyd

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Correspondence to Haejun C. Ahn.

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Adam Frymoyer is a scientific advisor and holds a financial interest in Halo Biosciences unrelated to the current work. The other authors have no conflict of interest to declare.

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Ahn, H.C., Frymoyer, A., Boothroyd, D.B. et al. Acute kidney injury in neonates with hypoxic ischemic encephalopathy based on serum creatinine decline compared to KDIGO criteria. Pediatr Nephrol (2024). https://doi.org/10.1007/s00467-024-06287-8

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