Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study

Neonatal Kidney Collaborative (NKC)

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background Findings from single-centre studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, because of the small sample size of those studies, few inferences can been made regarding the independent associations between AKI, mortality, and hospital length of stay. We aimed to establish whether neonatal AKI is independently associated with increased mortality and length of hospital stay. Methods We did this multicentre, multinational, retrospective cohort study of critically ill neonates admitted to 24 participating neonatal intensive care units (NICUs) in four countries (Australia, Canada, India, USA) between Jan 1 and March 31, 2014. We included infants born or admitted to a level 2 or 3 NICU and those who received intravenous fluids for at least 48 h. Exclusion criteria were admission at age 14 days or older, congenital heart disease requiring surgical repair within 7 days of life, lethal chromosomal anomaly, death within 48 h of admission, inability to determine AKI status, or severe congenital kidney abnormalities. We defined AKI as an increase in serum creatinine of 0·3 mg/dL or more (≥26·5 μmol/L) or 50% or more from the previous lowest value, or a urinary output of less than 1 mL/kg per h on postnatal days 2–7. We used logistic regression to calculate crude odds ratios (ORs) and associated 95% CIs for the association between AKI and likelihood of death. We used linear regression to calculate the crude parameter estimates and associated 95% CIs for the association between AKI and length of hospital stay. Multivariable logistic and linear regression models were run to account for potential confounding variables. We additionally created regression models stratified by gestational age groups (22 weeks to <29 weeks, 29 weeks to <36 weeks, and ≥36 weeks). This study is registered with ClinicalTrials.gov, number NCT02443389. Findings We enrolled 2162 infants, of whom 2022 (94%) had data to ascertain AKI status. 605 (30%) infants had AKI. Incidence of AKI varied by gestational age group, occurring in 131 (48%) of 273 of patients born at 22 weeks to less than 29 weeks, 168 (18%) of 916 patients born at 29 weeks to less than 36 weeks, and 306 (37%) of 833 patients born at 36 weeks or older. Infants with AKI had higher mortality than those without AKI (59 [10%] of 605 vs 20 [1%] of 1417 infants; p<0·0001), and longer length of hospital stay (median 23 days [IQR 10–61] vs 19 days [9–36]; p<0·0001). These findings were confirmed in both crude analysis of mortality (OR 7·5, 95% CI 4·5–12·7; p<0·0001 for AKI vs no AKI) and length of stay (parameter estimate 14·9 days, 95% CI 11·6–18·1; p<0·0001) and analysis adjusted for multiple confounding factors (adjusted OR 4·6, 95% CI 2·5–8·3; p<0·0001 and adjusted parameter estimate 8·8 days, 95% CI 6·1–11·5; p<0·0001, respectively). Interpretation Neonatal AKI is a common and independent risk factor for mortality and increased length of hospital stay. These data suggest that AKI might have a similar effect in neonates as in paediatric and adult patients. Strategies designed to prevent AKI and treatments to reduce the burden of AKI, including renal support devices designed for neonates, are greatly needed to improve the outcomes of these vulnerable infants. Funding US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children's Hospital, University of New Mexico, Canberra Hospital Private Practice fund, and 100 Women Who Care.

Original languageEnglish (US)
Pages (from-to)184-194
Number of pages11
JournalThe Lancet Child and Adolescent Health
Volume1
Issue number3
DOIs
StatePublished - Nov 1 2017

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Acute Kidney Injury
Observational Studies
Cohort Studies
Incidence
Length of Stay
Mortality
Linear Models
Neonatal Intensive Care Units
Odds Ratio
Newborn Infant
Gestational Age
Age Groups
Logistic Models
Kidney
Confounding Factors (Epidemiology)
Private Practice
National Institutes of Health (U.S.)
Financial Management
Critical Illness
Sample Size

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology

Cite this

Incidence and outcomes of neonatal acute kidney injury (AWAKEN) : a multicentre, multinational, observational cohort study. / Neonatal Kidney Collaborative (NKC).

In: The Lancet Child and Adolescent Health, Vol. 1, No. 3, 01.11.2017, p. 184-194.

Research output: Contribution to journalArticle

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title = "Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study",
abstract = "Background Findings from single-centre studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, because of the small sample size of those studies, few inferences can been made regarding the independent associations between AKI, mortality, and hospital length of stay. We aimed to establish whether neonatal AKI is independently associated with increased mortality and length of hospital stay. Methods We did this multicentre, multinational, retrospective cohort study of critically ill neonates admitted to 24 participating neonatal intensive care units (NICUs) in four countries (Australia, Canada, India, USA) between Jan 1 and March 31, 2014. We included infants born or admitted to a level 2 or 3 NICU and those who received intravenous fluids for at least 48 h. Exclusion criteria were admission at age 14 days or older, congenital heart disease requiring surgical repair within 7 days of life, lethal chromosomal anomaly, death within 48 h of admission, inability to determine AKI status, or severe congenital kidney abnormalities. We defined AKI as an increase in serum creatinine of 0·3 mg/dL or more (≥26·5 μmol/L) or 50{\%} or more from the previous lowest value, or a urinary output of less than 1 mL/kg per h on postnatal days 2–7. We used logistic regression to calculate crude odds ratios (ORs) and associated 95{\%} CIs for the association between AKI and likelihood of death. We used linear regression to calculate the crude parameter estimates and associated 95{\%} CIs for the association between AKI and length of hospital stay. Multivariable logistic and linear regression models were run to account for potential confounding variables. We additionally created regression models stratified by gestational age groups (22 weeks to <29 weeks, 29 weeks to <36 weeks, and ≥36 weeks). This study is registered with ClinicalTrials.gov, number NCT02443389. Findings We enrolled 2162 infants, of whom 2022 (94{\%}) had data to ascertain AKI status. 605 (30{\%}) infants had AKI. Incidence of AKI varied by gestational age group, occurring in 131 (48{\%}) of 273 of patients born at 22 weeks to less than 29 weeks, 168 (18{\%}) of 916 patients born at 29 weeks to less than 36 weeks, and 306 (37{\%}) of 833 patients born at 36 weeks or older. Infants with AKI had higher mortality than those without AKI (59 [10{\%}] of 605 vs 20 [1{\%}] of 1417 infants; p<0·0001), and longer length of hospital stay (median 23 days [IQR 10–61] vs 19 days [9–36]; p<0·0001). These findings were confirmed in both crude analysis of mortality (OR 7·5, 95{\%} CI 4·5–12·7; p<0·0001 for AKI vs no AKI) and length of stay (parameter estimate 14·9 days, 95{\%} CI 11·6–18·1; p<0·0001) and analysis adjusted for multiple confounding factors (adjusted OR 4·6, 95{\%} CI 2·5–8·3; p<0·0001 and adjusted parameter estimate 8·8 days, 95{\%} CI 6·1–11·5; p<0·0001, respectively). Interpretation Neonatal AKI is a common and independent risk factor for mortality and increased length of hospital stay. These data suggest that AKI might have a similar effect in neonates as in paediatric and adult patients. Strategies designed to prevent AKI and treatments to reduce the burden of AKI, including renal support devices designed for neonates, are greatly needed to improve the outcomes of these vulnerable infants. Funding US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children's Hospital, University of New Mexico, Canberra Hospital Private Practice fund, and 100 Women Who Care.",
author = "{Neonatal Kidney Collaborative (NKC)} and Jetton, {Jennifer G.} and Boohaker, {Louis J.} and Sethi, {Sidharth K.} and Sanjay Wazir and Smriti Rohatgi and Soranno, {Danielle E.} and Chishti, {Aftab S.} and Robert Woroniecki and Cherry Mammen and Swanson, {Jonathan R.} and Shanthy Sridhar and Wong, {Craig S.} and Kupferman, {Juan C.} and Griffin, {Russell L.} and Askenazi, {David J.} and Selewski, {David T.} and Subrata Sarkar and Alison Kent and Jeffery Fletcher and Abitbol, {Carolyn L.} and Marissa DeFreitas and Shahnaz Duara and Charlton, {Jennifer R.} and Ronnie Guillet and Carl D'Angio and Ayesa Mian and Erin Rademacher and Mhanna, {Maroun J.} and Rupesh Raina and Deepak Kumar and Namasivayam Ambalavanan and Arikan, {Ayse Akcan} and Rhee, {Christopher J.} and Goldstein, {Stuart L.} and Nathan, {Amy T.} and Alok Bhutada and Shantanu Rastogi and Elizabeth Bonachea and Susan Ingraham and John Mahan and Arwa Nada and Brophy, {Patrick D.} and Colaizy, {Tarah T.} and Klein, {Jonathan M.} and Cole, {F. Sessions} and Davis, {T. Keefe} and Joshua Dower and Mamta Fuloria and Kimberly Reidy and Kaskel, {Frederick J.}",
year = "2017",
month = "11",
day = "1",
doi = "10.1016/S2352-4642(17)30069-X",
language = "English (US)",
volume = "1",
pages = "184--194",
journal = "The Lancet Child and Adolescent Health",
issn = "2352-4642",
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TY - JOUR

T1 - Incidence and outcomes of neonatal acute kidney injury (AWAKEN)

T2 - a multicentre, multinational, observational cohort study

AU - Neonatal Kidney Collaborative (NKC)

AU - Jetton, Jennifer G.

AU - Boohaker, Louis J.

AU - Sethi, Sidharth K.

AU - Wazir, Sanjay

AU - Rohatgi, Smriti

AU - Soranno, Danielle E.

AU - Chishti, Aftab S.

AU - Woroniecki, Robert

AU - Mammen, Cherry

AU - Swanson, Jonathan R.

AU - Sridhar, Shanthy

AU - Wong, Craig S.

AU - Kupferman, Juan C.

AU - Griffin, Russell L.

AU - Askenazi, David J.

AU - Selewski, David T.

AU - Sarkar, Subrata

AU - Kent, Alison

AU - Fletcher, Jeffery

AU - Abitbol, Carolyn L.

AU - DeFreitas, Marissa

AU - Duara, Shahnaz

AU - Charlton, Jennifer R.

AU - Guillet, Ronnie

AU - D'Angio, Carl

AU - Mian, Ayesa

AU - Rademacher, Erin

AU - Mhanna, Maroun J.

AU - Raina, Rupesh

AU - Kumar, Deepak

AU - Ambalavanan, Namasivayam

AU - Arikan, Ayse Akcan

AU - Rhee, Christopher J.

AU - Goldstein, Stuart L.

AU - Nathan, Amy T.

AU - Bhutada, Alok

AU - Rastogi, Shantanu

AU - Bonachea, Elizabeth

AU - Ingraham, Susan

AU - Mahan, John

AU - Nada, Arwa

AU - Brophy, Patrick D.

AU - Colaizy, Tarah T.

AU - Klein, Jonathan M.

AU - Cole, F. Sessions

AU - Davis, T. Keefe

AU - Dower, Joshua

AU - Fuloria, Mamta

AU - Reidy, Kimberly

AU - Kaskel, Frederick J.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background Findings from single-centre studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, because of the small sample size of those studies, few inferences can been made regarding the independent associations between AKI, mortality, and hospital length of stay. We aimed to establish whether neonatal AKI is independently associated with increased mortality and length of hospital stay. Methods We did this multicentre, multinational, retrospective cohort study of critically ill neonates admitted to 24 participating neonatal intensive care units (NICUs) in four countries (Australia, Canada, India, USA) between Jan 1 and March 31, 2014. We included infants born or admitted to a level 2 or 3 NICU and those who received intravenous fluids for at least 48 h. Exclusion criteria were admission at age 14 days or older, congenital heart disease requiring surgical repair within 7 days of life, lethal chromosomal anomaly, death within 48 h of admission, inability to determine AKI status, or severe congenital kidney abnormalities. We defined AKI as an increase in serum creatinine of 0·3 mg/dL or more (≥26·5 μmol/L) or 50% or more from the previous lowest value, or a urinary output of less than 1 mL/kg per h on postnatal days 2–7. We used logistic regression to calculate crude odds ratios (ORs) and associated 95% CIs for the association between AKI and likelihood of death. We used linear regression to calculate the crude parameter estimates and associated 95% CIs for the association between AKI and length of hospital stay. Multivariable logistic and linear regression models were run to account for potential confounding variables. We additionally created regression models stratified by gestational age groups (22 weeks to <29 weeks, 29 weeks to <36 weeks, and ≥36 weeks). This study is registered with ClinicalTrials.gov, number NCT02443389. Findings We enrolled 2162 infants, of whom 2022 (94%) had data to ascertain AKI status. 605 (30%) infants had AKI. Incidence of AKI varied by gestational age group, occurring in 131 (48%) of 273 of patients born at 22 weeks to less than 29 weeks, 168 (18%) of 916 patients born at 29 weeks to less than 36 weeks, and 306 (37%) of 833 patients born at 36 weeks or older. Infants with AKI had higher mortality than those without AKI (59 [10%] of 605 vs 20 [1%] of 1417 infants; p<0·0001), and longer length of hospital stay (median 23 days [IQR 10–61] vs 19 days [9–36]; p<0·0001). These findings were confirmed in both crude analysis of mortality (OR 7·5, 95% CI 4·5–12·7; p<0·0001 for AKI vs no AKI) and length of stay (parameter estimate 14·9 days, 95% CI 11·6–18·1; p<0·0001) and analysis adjusted for multiple confounding factors (adjusted OR 4·6, 95% CI 2·5–8·3; p<0·0001 and adjusted parameter estimate 8·8 days, 95% CI 6·1–11·5; p<0·0001, respectively). Interpretation Neonatal AKI is a common and independent risk factor for mortality and increased length of hospital stay. These data suggest that AKI might have a similar effect in neonates as in paediatric and adult patients. Strategies designed to prevent AKI and treatments to reduce the burden of AKI, including renal support devices designed for neonates, are greatly needed to improve the outcomes of these vulnerable infants. Funding US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children's Hospital, University of New Mexico, Canberra Hospital Private Practice fund, and 100 Women Who Care.

AB - Background Findings from single-centre studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, because of the small sample size of those studies, few inferences can been made regarding the independent associations between AKI, mortality, and hospital length of stay. We aimed to establish whether neonatal AKI is independently associated with increased mortality and length of hospital stay. Methods We did this multicentre, multinational, retrospective cohort study of critically ill neonates admitted to 24 participating neonatal intensive care units (NICUs) in four countries (Australia, Canada, India, USA) between Jan 1 and March 31, 2014. We included infants born or admitted to a level 2 or 3 NICU and those who received intravenous fluids for at least 48 h. Exclusion criteria were admission at age 14 days or older, congenital heart disease requiring surgical repair within 7 days of life, lethal chromosomal anomaly, death within 48 h of admission, inability to determine AKI status, or severe congenital kidney abnormalities. We defined AKI as an increase in serum creatinine of 0·3 mg/dL or more (≥26·5 μmol/L) or 50% or more from the previous lowest value, or a urinary output of less than 1 mL/kg per h on postnatal days 2–7. We used logistic regression to calculate crude odds ratios (ORs) and associated 95% CIs for the association between AKI and likelihood of death. We used linear regression to calculate the crude parameter estimates and associated 95% CIs for the association between AKI and length of hospital stay. Multivariable logistic and linear regression models were run to account for potential confounding variables. We additionally created regression models stratified by gestational age groups (22 weeks to <29 weeks, 29 weeks to <36 weeks, and ≥36 weeks). This study is registered with ClinicalTrials.gov, number NCT02443389. Findings We enrolled 2162 infants, of whom 2022 (94%) had data to ascertain AKI status. 605 (30%) infants had AKI. Incidence of AKI varied by gestational age group, occurring in 131 (48%) of 273 of patients born at 22 weeks to less than 29 weeks, 168 (18%) of 916 patients born at 29 weeks to less than 36 weeks, and 306 (37%) of 833 patients born at 36 weeks or older. Infants with AKI had higher mortality than those without AKI (59 [10%] of 605 vs 20 [1%] of 1417 infants; p<0·0001), and longer length of hospital stay (median 23 days [IQR 10–61] vs 19 days [9–36]; p<0·0001). These findings were confirmed in both crude analysis of mortality (OR 7·5, 95% CI 4·5–12·7; p<0·0001 for AKI vs no AKI) and length of stay (parameter estimate 14·9 days, 95% CI 11·6–18·1; p<0·0001) and analysis adjusted for multiple confounding factors (adjusted OR 4·6, 95% CI 2·5–8·3; p<0·0001 and adjusted parameter estimate 8·8 days, 95% CI 6·1–11·5; p<0·0001, respectively). Interpretation Neonatal AKI is a common and independent risk factor for mortality and increased length of hospital stay. These data suggest that AKI might have a similar effect in neonates as in paediatric and adult patients. Strategies designed to prevent AKI and treatments to reduce the burden of AKI, including renal support devices designed for neonates, are greatly needed to improve the outcomes of these vulnerable infants. Funding US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children's Hospital, University of New Mexico, Canberra Hospital Private Practice fund, and 100 Women Who Care.

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