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Renal oximetry for early acute kidney injury detection in neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia

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Abstract

Background

Neonates with hypoxic ischemic encephalopathy (HIE) receiving therapeutic hypothermia are at high risk of acute kidney injury (AKI).

Methods

We performed a two-site prospective observational study from 2018 to 2019 to evaluate the utility of renal near-infrared spectroscopy (NIRS) in detecting AKI in 38 neonates with HIE receiving therapeutic hypothermia. AKI was defined by a delayed rate of serum creatinine decline (< 33% on day 3 of life, < 40% on day 5, and < 46% on day 7). Renal saturation (Rsat) and systemic oxygen saturation (SpO2) were continuously measured for the first 96 h of life (HOL). Renal fractional tissue oxygen extraction (RFTOE) was calculated as (SpO2 − Rsat)/(SpO2). Using renal NIRS, urine biomarkers, and perinatal factors, logistic regression was performed to develop a model that predicted AKI.

Results

AKI occurred in 20 of 38 neonates (53%). During the first 96 HOL, Rsat was higher, and RFTOE was lower in the AKI group vs. the no AKI group (P < 0.001). Rsat > 70% had a fair predictive performance for AKI at 48–84 HOL (AUC 0.71–0.79). RFTOE ≤ 25 had a good predictive performance for AKI at 42–66 HOL (AUC 0.8–0.83). The final statistical model with the best fit to predict AKI (AUC = 0.88) included RFTOE at 48 HOL (P = 0.012) and pH of the infants’ first postnatal blood gas (P = 0.025).

Conclusions

Lower RFTOE on renal NIRS and pH on infant first blood gas may be early predictors for AKI in neonates with HIE receiving therapeutic hypothermia.

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Abbreviations

AKI:

Acute kidney injury

DOL:

Day of life

HIE:

Hypoxic ischemic encephalopathy

HOL:

Hour of life

KDIGO:

Kidney Disease: Improving Global Outcomes

MRI:

Magnetic resonance imaging

NICU:

Neonatal intensive care units

NIRS:

Near infrared spectroscopy

R sat :

Renal saturation

RFTOE:

Renal fractional tissue oxygen extraction

SCr:

Serum creatinine

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Acknowledgements

The authors would like to thank Donnal Walters, MD, NIRS data analysis, University of Arkansas for Medical Sciences, Little Rock, AR.

Funding

This work was supported by the Arkansas Children’s Research Institute and Arkansas Biosciences Institute. The study sponsors did not have any role in the (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the manuscript for publication. No form of payment was given to anyone to produce the manuscript.

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Authors and Affiliations

  1. Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Jennifer A. Rumpel, Sydney Rogers & Sherry E. Courtney

  2. Arkansas Children’s Hospital, One Children’s Way Slot 512-5, Little Rock, AR, 72205, USA

    Jennifer A. Rumpel

  3. Arkansas Children’s Research Institute, Little Rock, AR, USA

    Beverly J. Spray

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

    Adam Frymoyer, Seo-Ho Cho & Valerie Y. Chock

  5. Division of Nephrology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Saritha Ranabothu & Richard Blaszak

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  1. Jennifer A. Rumpel
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jennifer Rumpel, Beverly J. Spray, Adam Frymoyer, Sydney Rogers, Seo-Ho Cho, Richard Blaszak, Sherry E. Courtney, and Valerie Y. Chock. The first draft of the manuscript was written by Jennifer Rumpel, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jennifer A. Rumpel.

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Competing interests

The other authors do not have any conflicts of interest to declare for this study. AF is a scientific advisor and holds a financial interest in Halo Biosciences, which is unrelated to the submitted work.

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NIRS data from this study were presented in a virtual podium presentation at the Pediatric Academic Society (PAS) meeting in 2021. Urine biomarker data from this cohort were published in the Journal of Pediatrics in a manuscript entitled “Urine Biomarkers for the Assessment of Acute Kidney Injury in Neonates with Hypoxic Ischemic Encephalopathy Receiving Therapeutic Hypothermia” (Rumpel et al. 2022).

Supplementary Information

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Graphical Abstract (PPTX 198 KB)

467_2023_5892_MOESM2_ESM.pptx

Supplemental Fig. S1a Receiver operating curve for NIRS renal saturation for prediction of AKI using a delayed rate of SCr decline at 24, 48, and 72 hours of life. 1b. Receiver operating curve for NIRS RFTOE for prediction of AKI using a delayed rate of SCr decline at 24, 48, and 72 hours of life. (PPTX 228 KB)

467_2023_5892_MOESM3_ESM.docx

Supplemental Fig. S2 Receiver operating curve for NIRS RFTOE and infant first blood gas pH for prediction of AKI using a delayed rate of SCr decline at 24, 48, and 72 hours of life. (DOCX 99 KB)

Supplementary file4 (DOCX 27.2 KB)

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Rumpel, J.A., Spray, B.J., Frymoyer, A. et al. Renal oximetry for early acute kidney injury detection in neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia. Pediatr Nephrol 38, 2839–2849 (2023). https://doi.org/10.1007/s00467-023-05892-3

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