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Congenital anomalies of the kidney and urinary tract (CAKUT) in critically ill infants: a multicenter cohort study

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Abstract

Background

The aim of the study was to determine the prevalence of congenital anomalies of the kidney and urinary tract (CAKUT) in the neonatal intensive care unit (NICU) and to evaluate risk factors associated with worse outcomes. We hypothesized that infants with CAKUT with extra-renal manifestations have higher mortality.

Methods

This is a cohort study of all inborn infants who were diagnosed with any form of CAKUT discharged from NICUs managed by the Pediatrix Medical Group from 1997 to 2018. Logistic and linear regression models were used to analyze risk factors associated with in-hospital mortality.

Results

The prevalence of CAKUT was 1.5% among infants hospitalized in 419 NICUs. Among the 13,383 infants with CAKUT analyzed, median gestational age was 35 (interquartile range [IQR] 31–38) weeks and median birth weight was 2.34 (IQR 1.54–3.08) kg. Overall in-hospital mortality for infants with CAKUT was 6.8%. Oligohydramnios (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] 2.2–9.1, p < 0.001), extra-renal anomalies (aOR 2.5, 95% CI 2.0–3.1, p < 0.001), peak SCr (aOR 1.02, 95% CI 1.01–1.03, p < 0.001) and exposure to nephrotoxic medications (aOR 1.4, 95% CI 1.1–1.7, p = 0.01) were associated with increased mortality, while a history of urological surgery or intervention was associated with lower mortality (aOR 0.6, 95% CI 0.4–0.7, p < 0.001).

Conclusions

Infants hospitalized in the NICU who have CAKUT and the independent risk factors for mortality (e.g., oligohydramnios and presence of extra-renal anomalies) require close monitoring, minimizing of exposure to nephrotoxic drugs, and timely urological surgery or intervention.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Paediatric Nephrology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Esther Huimin Leow & Yong Hong Ng

  2. Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore

    Jan Hau Lee

  3. Duke-NUS Medical School, Singapore, Singapore

    Jan Hau Lee

  4. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Christoph P. Hornik, Reese H. Clark & Rachel G. Greenberg

  5. Duke Clinical Research Institute, Durham, NC, USA

    Christoph P. Hornik & Rachel G. Greenberg

  6. Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York City, NY, USA

    Thomas Hays

  7. The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA

    Reese H. Clark & Veeral N. Tolia

  8. Department of Neonatology, Baylor University Medical Center and Pediatrix Medical Group, Dallas, TX, USA

    Veeral N. Tolia

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  1. Esther Huimin Leow
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. Rachel G Greenberg. The first draft of the manuscript was written by Dr. Esther Huimin Leow and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Esther Huimin Leow.

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Leow, E.H., Lee, J.H., Hornik, C.P. et al. Congenital anomalies of the kidney and urinary tract (CAKUT) in critically ill infants: a multicenter cohort study. Pediatr Nephrol 38, 161–172 (2023). https://doi.org/10.1007/s00467-022-05542-0

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  • DOI: https://doi.org/10.1007/s00467-022-05542-0

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