626 - Inpatient and outpatient management of anemia in infants with CKD during 1st year of life

Publication Number: 626.5115

Salar Bani Hani, NewYork-Presbyterian Komansky Children’s Hospital, New York CIty, NY, United States; Juhong Lee, Weill Cornell Medicine, New York, NY, United States; Abhinav G. Parikh, Weill Cornell Medicine, Brooklyn, NY, United States; Ali M. Nadroo, NYP Brooklyn Methodist hospital Weill Cornell Medicine, BROOKLYN, NY, United States; Camilia R. Martin, Weill Cornell Medicine, New York, NY, United States; Oleh Akchurin, Weill Cornell Medical College, New York, NY, United States

Background: Anemia and kidney dysfunction are common in NICU-managed neonates. While prolonged kidney dysfunction impairs erythropoiesis in older children, its impact on anemia management in NICUs is unclear. The transition of anemia management from NICU to outpatient nephrology clinics in infants with significant kidney disease is crucial but uninvestigated.

Objective: To define inpatient and outpatient anemia management patterns in NICU patients diagnosed with CKD within the first year of life.

Design/Methods: This retrospective cohort study included infants referred to pediatric nephrology within a large urban healthcare network from 2014 to 2022, diagnosed with CKD within the first 12 months, who received NICU care, and had relevant variables available. Eligible patients were identified through electronic medical records.

Results: We identified 37 patients, 30 with sufficient inpatient, and 24 with follow-up outpatient data. 73% were male, 40% born prematurely. At 12 months, 29% had stage 1 CKD, 12.5% stage 2, 33% stage 3, 12.5% stage 4, and 12.5% stage 5 (all on dialysis). CKD was caused by CAKUT in 88%, with PUV being the most common anomaly (33%). 76% did not receive antibiotics beyond the first 48 hours. The hemoglobin nadir in the NICU was 11.2±3.3 mg/dL, with 37% having hemoglobin < 10.0. During the NICU stay, 58% received iron supplementation, 37.5% received ESAs, and 21% received blood transfusions. There was a significant correlation (p=0.006) between hemoglobin nadir in the NICU and eGFR at 12 months (r=0.6).

At 12 months, 21% had anemia (KDIGO definition); 37% were receiving iron therapy, and 25% were receiving ESAs. Of the 8 patients not requiring iron in the NICU, only one started iron by 12 months. Of the 14 treated with iron in the NICU, 10 remained on iron at 12 months. Iron status was assessed in 21% during NICU stay and 33% post-discharge, with 50% being iron-deficient (TSAT < 20%).

Conclusion(s): In NICU patients developing CKD within the first year, anemia severity during NICU stay correlates with CKD severity at 12 months, indicating early kidney disease impacts anemia development. Most CKD patients starting iron in the NICU continued it post-discharge. A multicenter study is being launched to further investigate the role of kidney disease in anemia development in infants with CKD transitioning from NICUs to outpatient settings.

Table 1. General clinical characteristics of study cohort
37 patients met our inclusion criteria, 30 of whom had sufficient inpatient data.

Table 2. Serum creatinine and hemoglobin in the NICU by CKD stage at 12 months
Correlations between Glomerular Filtration Rate (GFR) at age 12 months and hemoglobin nadir in NICU, peak creatinine in NICU and discharge creatinine .

Figure 1. Correlation between hemoglobin nadir in the NICU and GFR at 12 months in infants with CKD.
Caption: GFR, glomerular filtration rate (bedside Schwartz formula), n=24, Pearson coefficient of correlation r=0.6, p=0.006.

Table 1. General clinical characteristics of study cohort
37 patients met our inclusion criteria, 30 of whom had sufficient inpatient data.

Table 2. Serum creatinine and hemoglobin in the NICU by CKD stage at 12 months
Correlations between Glomerular Filtration Rate (GFR) at age 12 months and hemoglobin nadir in NICU, peak creatinine in NICU and discharge creatinine .

Figure 1. Correlation between hemoglobin nadir in the NICU and GFR at 12 months in infants with CKD.
Caption: GFR, glomerular filtration rate (bedside Schwartz formula), n=24, Pearson coefficient of correlation r=0.6, p=0.006.