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Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study

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Abstract

Background

Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease.

Objectives

To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU.

Methods

This single-center prospective cohort study included all infants who received level II or III NICU care during 2015 (January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence interval (95% CI).

Results

The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32 ± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3–9) and perinatal depression (RR, 10; 95% CI, 2–46) were significantly associated with an increased risk of AKI. For infants with gestational age < 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95% CI, 1–3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2–14), but not with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference: 14 days; 95% CI, 5.5–23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels (> 65 μmol/L).

Conclusion

AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after discharge is warranted in such infants.

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Funding

This project was funded by King Abdulaziz City for Science and Technology (KACST) under grant number 27-35–T-A (أ ت–35–27). We would also like to thank Walaa Saleh Alharthi, Rahaf Mohamad Qari, Reem Jalal Alshareef, and Farah Haytham Alasadi for their assistance in data collection.

Author information

Authors and Affiliations

  1. Pediatric Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

    Mohamed A. Shalaby & Jameela A. Kari

  2. Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia

    Zinab A. Sawan & Esraa Nawawi

  3. Neonatal Intensive Care Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

    Saad Alsaedi & Heidi Al-Wassia

Authors
  1. Mohamed A. Shalaby
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  2. Zinab A. Sawan
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  3. Esraa Nawawi
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  4. Saad Alsaedi
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  5. Heidi Al-Wassia
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  6. Jameela A. Kari
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Corresponding author

Correspondence to Zinab A. Sawan.

Ethics declarations

The Biomedical Ethics Research Committee of the Faculty of Medicine at King Abdulaziz University granted ethical approval for this study. The need for informed patient consent was waived on account of the fact that this was a purely observational study that did not involve any specific therapeutic intervention, additional blood work, or change in clinical management.

Conflict of interest

The authors declare that they have no conflict of interest.

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Shalaby, M.A., Sawan, Z.A., Nawawi, E. et al. Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study. Pediatr Nephrol 33, 1617–1624 (2018). https://doi.org/10.1007/s00467-018-3966-7

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  • DOI: https://doi.org/10.1007/s00467-018-3966-7

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