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Diuretic therapy and acute kidney injury in preterm neonates and infants

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Abstract

Background

Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated.

Methods

This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated.

Results

Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders.

Conclusions

Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI.

Graphical abstract

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Data availability

All relevant raw data are freely available.

Code availability

Not applicable

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Acknowledgements

We would like to thank Dr. Elizabeth Bonachea for her thoughtful reading of the manuscript.

Funding

This work is supported by an internal funding from the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

Author information

Authors and Affiliations

  1. Division of Nephrology and Hypertension, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH, USA

    Tahagod H. Mohamed, Brett Klamer, John D. Mahan & John D. Spencer

  2. Nephrology and Urology Research Affinity Group, Nationwide Children’s Hospital, Columbus, OH, USA

    Tahagod H. Mohamed, John D. Mahan & John D. Spencer

  3. Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, OH, USA

    Tahagod H. Mohamed, John D. Mahan, John D. Spencer & Jonathan L. Slaughter

  4. The Center of Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Brett Klamer & John D. Spencer

  5. Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA

    Brett Klamer

  6. The Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Jonathan L. Slaughter

  7. Division of Epidemiology, College of Public Health, The Ohio State University College of Medicine, Columbus, Ohio, USA

    Jonathan L. Slaughter

Authors
  1. Tahagod H. Mohamed
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  2. Brett Klamer
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  4. John D. Spencer
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  5. Jonathan L. Slaughter
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Contributions

THM conseptualized and designed the study, collected data, analyzed the data, drafted the initial manuscript and reviewed and revised the manuscript. BK carried out the analysis and reviewed and revised the manuscript. JDM, JDS and JLS analyzed the data and reviewed and revised the manuscript.

Corresponding author

Correspondence to Tahagod H. Mohamed.

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Consent to participate

The Nationwide Children’s Hospital Institutional Review Board determined that this preexisting deidentified data was not human subjects’ research.

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Competing interests

The authors declare no competing interests.

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Mohamed, T.H., Klamer, B., Mahan, J.D. et al. Diuretic therapy and acute kidney injury in preterm neonates and infants. Pediatr Nephrol 36, 3981–3991 (2021). https://doi.org/10.1007/s00467-021-05132-6

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  • DOI: https://doi.org/10.1007/s00467-021-05132-6

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