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Comparison of different definitions of acute kidney injury in extremely low birth weight infants

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Abstract

Background

The definition of acute kidney injury (AKI) has evolved over the years, and three definitions have been adapted including pediatric risk injury failure, loss of kidney function (pRIFLE), Acute Kidney Injury Network (AKIN), and Neonatal Modified Kidney Disease Improving Global Outcomes (KDIGO). We sought to report the prevalence and outcome of (AKI) according to the three existing definitions in extremely low birth weight (ELBW) infants.

Methods

In a retrospective cohort study, medical records of all ELBW infants (<1000 g) admitted to our neonatal intensive care unit (NICU) between Jan 2002 and Dec 2011 were reviewed. Infants’ demographics, anthropometric measurements, and clinical characteristics were collected at the time of birth and at discharge from the NICU. Infants were staged according to the three different definitions.

Results

During the study period, 483 ELBW infants met our inclusion criteria. The incidence of AKI was 56, 59, and 60% according to pRIFLE, AKIN, and KDIGO, respectively. Mortality, NICU length of stay, and serum creatinine (SCr) at NICU discharge were higher in infants with advanced AKI stages regardless of the definition. In addition, discharge NICU weight and length z scores were lower in infants with advanced AKI stages. SCr at 72 h of life and SCr peak were predictable of NICU mortality [AUC 0.667 (95% CI 0.604–0.731), p < 0.001 and AUC 0.747 (95% CI 0.693–0.801), p < 0.001, respectively].

Conclusion

Regardless of the definition, advanced AKI is associated with increased mortality, prolonged NICU length of stay, and poor growth in ELBW infants. SCr at 72 h of life and SCr peak may be predictable of NICU mortality.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Metro Health Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Vikas Chowdhary, Mohit Jain, Syeda Maqsood, Rupesh Raina, Deepak Kumar & Maroun J. Mhanna

  2. Division of Pediatric Nephrology, Department of Pediatrics, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Rupesh Raina

  3. Division of Pediatric Nephrology, Akron Children’s Hospital, Akron, OH, USA

    Ramya Vajpeyajula & Rupesh Raina

  4. Division of Nephrology, Akron General Medical Center, Cleveland Clinic Foundation, Akron, OH, USA

    Ramya Vajpeyajula & Rupesh Raina

Authors
  1. Vikas Chowdhary
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  2. Ramya Vajpeyajula
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  3. Mohit Jain
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  4. Syeda Maqsood
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  5. Rupesh Raina
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  6. Deepak Kumar
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  7. Maroun J. Mhanna
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Corresponding author

Correspondence to Maroun J. Mhanna.

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Funding

None to report.

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the hospital’s Institutional Review Board at Metro Health Medical Center (IRB Approval Number: IRB 15-00071) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The informed consent was waived by the Institutional review Board at Metro Health Medical Center, since the patients had left the institution at the time of the study and the study subjects were de-identified.

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Chowdhary, V., Vajpeyajula, R., Jain, M. et al. Comparison of different definitions of acute kidney injury in extremely low birth weight infants. Clin Exp Nephrol 22, 117–125 (2018). https://doi.org/10.1007/s10157-017-1430-9

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  • DOI: https://doi.org/10.1007/s10157-017-1430-9

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