005 - Incidence, Predictors, and Outcomes Associated with Recurrent Neonatal Acute Kidney Injury in Preterm Infants: A Report from the ALMOND Study

Publication Number: 5.5274

Katherine Vincent, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Matthew C. Gillen, Emory University School of Medicine, Atlanta, GA, United States; Austin Rutledge, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Russell Griffin, University of Alabama at Birmingham, Birmingham, AL, United States; Tara Beck, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Aadil Kakajiwala, Children’s National Hospital, Washington, DC, United States; Semsa Gogcu, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Thomas A. Forbes, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Michelle Starr, Indiana University School of Medicine, Indianapolis, IN, United States; Judit Klara. Kiss, University of Szeged, Szeged, Csongrad, Hungary; David Selewski, Medical University of South Carolina, Mount Pleasant, SC, United States; Heidi J.. Steflik, Medical University of South Carolina College of Medicine, Charleston, SC, United States

Background: Recurrent neonatal acute kidney injury (rAKI) may be associated with increased morbidity and mortality but remains understudied.

Objective: We aimed to determine the incidence, risk factors, and clinical outcomes associated with rAKI in extremely low gestational age newborns (ELGANs) hypothesizing ELGANs are at risk for rAKI which will be associated with worsened short and long-term outcomes compared to ELGANs with no AKI or single (sAKI).

Design/Methods: We performed a secondary analysis (ALMOND study) of the multicenter Preterm Erythropoietin Neuroprotection Trial (PENUT), a randomized trial of erythropoietin in ELGANs conducted 2013-2016. AKI was diagnosed retrospectively using the modified, neonatal Kidney Disease: Improving Global Outcomes serum creatinine criteria. Diagnosis of a rAKI episode required return to baseline serum creatinine for each previous AKI episode. Outcomes included length of stay (LOS), bronchopulmonary dysplasia (BPD), mortality, and chronic kidney disease (CKD) and hypertension (HTN) at 2 years of age. Comparisons were made between those with no AKI, sAKI, and rAKI. Associations between rAKI and outcomes were evaluated using multivariable, general estimating equation linear and logistic regression as well as Cox proportional hazards regression to analyze time varying effects of AKI status on outcomes.

Results: Of 923 ELGANs included, 211 (23%) developed rAKI. Risk factors for rAKI included younger gestational age, lower birthweight, small for gestational age, lower APGARs, patent ductus arteriosus, severe sepsis, nephrotoxic medication exposure, hypotension, BPD, and necrotizing enterocolitis (all p< 0.05).

Compared to those without AKI, ELGANs with rAKI experienced a longer LOS with a lower hazard of discharge (rAKI 108 (IQR 85-139) days vs. no AKI 88 (70-105) days; aHR 0.58, 95%CI 0.45-0.74) and increased mortality (rAKI 12% vs. no AKI 9%; aHR 2.79, 95%CI 1.05-7.46) after adjusting for multiple confounders (Figure). Compared to those with sAKI, ELGANs with rAKI experienced a longer LOS with a lower hazard of discharge (rAKI 108 (85-139) days vs. sAKI 93 (71-114) days; aHR 0.71, 95%CI 0.56-0.89) but no differences in mortality after adjusting for multiple confounders (Figure).There was no difference in the adjusted relative risk of BPD nor CKD or HTN at 2 years of age in ELGANS with rAKI compared to those with no AKI or sAKI.

Conclusion(s): In the PENUT cohort, rAKI is independently associated with longer LOS and increased mortality however, neither CKD nor HTN at 2 years was associated with rAKI.

Associations between No Acute Kidney Injury, Single Acute Kidney Injury, and Recurrent Acute Kidney Injury and Short-term and Long-term Clinical Outcomes