Abstract
Background: Data from adult and pediatric literature have shown an association between albumin levels and AKI. Whether hypoalbuminemia and neonatal AKI are associated has not been studied. Methods: We evaluated the association of albumin with early (during the first postnatal week) and late (after the first postnatal week) AKI for 531 neonates from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database and for 3 gestational age (GA) subgroups: < 29, 29 to < 36, and ≥ 36 weeks GA. Results: Low albumin levels were associated with increased odds of neonatal AKI; for every 0.1 g/dL decrease in albumin, the odds of late AKI increased by 12% on continuous analysis. After adjustment for potential confounders, neonates with albumin values in the lowest quartiles (< 2.2 g/dL) had an increased odds of early [Adjusted Odd Ratio (AdjOR) 2.5, 95% CI = 1.1–5.3, p < 0.03] and late AKI [AdjOR 13.4, 95% CI = 3.6–49.9, p < 0.0001] compared to those with albumin in the highest quartile (> 3.1 g/dL). This held true for albumin levels 2.3 to 2.6 g/dL for early [AdjOR 2.5, 95% CI = 1.2–5.5, p < 0.02] and late AKI [AdjOR 6.4, 95% CI = 1.9–21.6, p < 0.01]. Albumin quartiles of (2.7 to 3.0 g/dL) were associated with increased odds of late AKI. Albumin levels of 2.6 g/dL and 2.4 g/dL best predicted early (AUC = 0.59) and late AKI (AUC = 0.64), respectively. Analysis of albumin association with AKI by GA is described. Conclusions: Low albumin levels are independently associated with early and late neonatal AKI. Albumin could be a potential modifiable risk factor for neonatal AKI.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1675-1686 |
| Number of pages | 12 |
| Journal | Pediatric Nephrology |
| Volume | 37 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2022 |
Keywords
- Hypoalbuminemia
- Infants
- Kidney failure
- Risk factors
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Nephrology
Fingerprint
Dive into the research topics of 'Low albumin levels are independently associated with neonatal acute kidney injury: a report from AWAKEN Study Group'. Together they form a unique fingerprint.Cite this
- APA
- Standard
- Harvard
- Vancouver
- Author
- BIBTEX
- RIS
In: Pediatric Nephrology, Vol. 37, No. 7, 07.2022, p. 1675-1686.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Low albumin levels are independently associated with neonatal acute kidney injury
T2 - a report from AWAKEN Study Group
AU - the AWAKEN Collaborative
AU - Nada, Arwa
AU - Askenazi, David
AU - Kupferman, Juan C.
AU - Mhanna, Maroun
AU - Mahan, John D.
AU - Boohaker, Louis
AU - Li, Linzi
AU - Griffin, Russell L.
AU - Selewski, David T.
AU - Ambalavanan, Namasivayam
AU - Sarkar, Subrata
AU - Kent, Alison
AU - Fletcher, Jeffery
AU - Abitbol, Carolyn L.
AU - DeFreitas, Marissa
AU - Duara, Shahnaz
AU - Charlton, Jennifer
AU - Swanson, Jonathan R.
AU - Brophy, Patrick D.
AU - Guillet, Ronnie
AU - D’Angio, Carl
AU - Mian, Ayesa
AU - Rademacher, Erin
AU - Raina, Rupesh
AU - Kumar, Deepak
AU - Jetton, Jennifer G.
AU - Colaizy, Tarah T.
AU - Klein, Jonathan M.
AU - Akcan-Arikan, Ayse
AU - Joseph, Catherine
AU - Rhee, Christopher J.
AU - Bhutada, Alok
AU - Rastogi, Shantanu
AU - Cole, F. Sessions
AU - Davis, T. Keefe
AU - Milner, Lawrence
AU - Smith, Alexandra
AU - Fuloria, Mamta
AU - Kaskel, Frederick J.
AU - Reidy, Kimberly
AU - Gist, Katja M.
AU - Soranno, Danielle E.
AU - Gien, Jason
AU - Hanna, Mina
AU - Chishti, Aftab S.
AU - Hingorani, Sangeeta
AU - Starr, Michelle
AU - Wong, Craig S.
AU - DuPont, Tara
AU - Ohls, Robin
N1 - Funding Information: Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), and support for some of the AWAKEN investigators at UAB (LBJ, RJG). PICAN is part of the Department of Pediatrics at UAB and is funded by Children’s of Alabama, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR003096). The AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (CTSC, NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356). CLA was supported by the Micah Batchelor Foundation. AAA and CJR were supported by the Section of Pediatric Nephrology, Department of Pediatrics, Texas Children’s Hospital. JRC and JRS were supported by a grant from 100 Women Who Care. FSC and KTD were supported by the Edward Mallinckrodt Department of Pediatrics at Washington University School of Medicine. JF and AK were supported by the Canberra Hospital Private Practice Fund. RG and ER were supported by the Department of Pediatrics, Golisano Children’s Hospital, University of Rochester. PER was supported by R01 HL-102497, R01 DK 49419. SS and DTS were supported by the Department of Pediatrics & Communicable Disease, C.S. Mott Children’s Hospital, University of Michigan. SS and RW were supported by Stony Brook Children’s Hospital Department of Pediatrics funding. Funding sources for this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding Information: AWAKEN Investigators: The following individuals served as collaborators and site investigators for the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study and are collaborators on this manuscript and should be indexed in PubMed as collaborators on this manuscript (authors named above have been removed from this list): David T. Selewski, MD. Medical University of South Carolina, South Carolina Namasivayam Ambalavanan, MD. Children’s of Alabama, University of Alabama at Birmingham, Birmingham, Alabama. Subrata Sarkar, MD. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan. Alison Kent, MD, Jeffery Fletcher, PhD. Centenary Hospital for Women and Children, Canberra Hospital, Australian National University Medical School, Canberra, Australia. Carolyn L. Abitbol, MD, Marissa DeFreitas, MD, Shahnaz Duara, MD. Holtz Children’s Hospital, University of Miami, Miami, Florida. Jennifer Charlton, MD, Jonathan R. Swanson MD. University of Virginia Children’s Hospital, Charlottesville, Virginia. Patrick D. Brophy, MD, Ronnie Guillet, MD, Carl D’Angio, MD, Ayesa Mian, MD, Erin Rademacher, MD. Golisano Children’s Hospital, University of Rochester, Rochester, New York. Rupesh Raina, MD, Deepak Kumar, MD. MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. Jennifer G. Jetton, MD, Tarah T. Colaizy, MD, Jonathan M. Klein, MD. University of Iowa Children’s Hospital, Iowa City, Iowa. Ayse Akcan-Arikan, MD, Catherine Joseph, MD, Christopher J. Rhee, MD. Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas. Alok Bhutada, MD, Shantanu Rastogi, MD. Maimonides Medical Center, Brooklyn, New York. F. Sessions Cole, MD, T. Keefe Davis, MD. Washington University, St. Louis, Missouri. Lawrence Milner, MD, Alexandra Smith, MD. Tufts University School of Medicine, Boston, Massachusetts. Mamta Fuloria, MD, Frederick J. Kaskel, MD, Kimberly Reidy. The Children’s Hospital at Montefiore, Bronx, New York. Katja M. Gist, DO, Danielle E. Soranno, MD Jason Gien, MD. University of Colorado, Children’s Hospital Colorado, Aurora, Colorado. Mina Hanna, MD, Aftab S. Chishti, MD. University of Kentucky, Lexington, Kentucky. Sangeeta Hingorani, MD, Michelle Starr, MD. University of Washington, Seattle Children’s Hospital, Seattle, Washington. Craig S. Wong, MD, Tara DuPont, MD, Robin Ohls, MD. University of New Mexico Health Sciences Center, Albuquerque, New Mexico. Surender Khokhar, MD. Apollo Cradle, Gurgaon, Haryana, India. Sofia Perazzo, MD, Patricio E. Ray, Mary Revenis, MD. Children’s National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington DC. Sidharth K. Sethi, MD, Smriri Rohatgi, MD. Medanta, The Medicity, Gurgaon, India. Cherry Mammen, MD, Anne Synnes, MDCM. British Columbia Children’s Hospital, Vancouver, British Columbia, Canada. Sanjay Wazir, MD. Cloudnine Hospital, Gurgaon, Haryana, India. Michael Zappitelli, MD. Toronto Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Robert Woroniecki, MD, Shanty Sridhar, MD. Stony Brook School of Medicine, Stony Brook, New York. Stuart L. Goldstein, MD, Amy T. Nathan, MD. Cincinnati Children’s Hospital and Medical Center, University of Cincinnati, Cincinnati, OH. Amy Staples, MD. University of New Mexico, Department of Pediatrics, Albuquerque, NM. Pia Wintermark, MD. McGill University, Montreal, QC, Canada. The authors would also like to thank the outstanding work of the following clinical research personnel and colleagues for their involvement in AWAKEN: Ariana Aimani, Samantha Kronish, Ana Palijan, MD, Michael Pizzi. Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Laila Ajour, BS, Julia Wrona, BS. University of Colorado, Children’s Hospital Colorado, Aurora, Colorado. Melissa Bowman, RN. University of Rochester, Rochester, New York. Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse Cristina Pareja Valarezo, MD. Holtz Children’s Hospital, University of Miami, Miami, Florida. Sarah Cashman, BS, Madeleine Stead, BS. University of Iowa Children’s Hospital, Iowa City, Iowa. Jonathan Davis, MD, Julie Nicoletta, MD. Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts. Alanna DeMello. British Columbia Children’s Hospital, Vancouver, British Columbia, Canada. Lynn Dill, RN. University of Alabama at Birmingham, Birmingham, Alabama. Ellen Guthrie, RN. Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio. Nicholas L. Harris, BS, Susan M. Hieber, MSQM. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan. Katherine Huang, Rosa Waters. University of Virginia Children’s Hospital, Charlottesville, Virginia. Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell. Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio. Nilima Jawale, MD. Maimonides Medical Center, Brooklyn, New York. Emily Kane — Australian National University, Canberra, Australia. Vijay Kher, DM, Puneet Sodhi, MBBS. Medanta Kidney Institute, The Medicity Hospital, Gurgaon, Haryana, India. Grace Mele. New York College of Osteopathic Medicine, Westbury, New York. Patricia Mele, DNP. Stony Brook Children’s Hospital, Stony Brook, New York. Charity Njoku, Tennille Paulsen, Sadia Zubair. Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas. Emily Pao. University of Washington, Seattle Children’s Hospital, Seattle, Washington. Becky Selman RN, Michele Spear, CCRC. University of New Mexico Health Sciences Center Albuquerque, New Mexico. Melissa Vega, PA-C. The Children’s Hospital at Montefiore, Bronx, New York. Leslie Walther RN. Washington University, St. Louis, Missouri. Publisher Copyright: © 2021, The Author(s), under exclusive licence to International Pediatric Nephrology Association.
PY - 2022/7
Y1 - 2022/7
N2 - Background: Data from adult and pediatric literature have shown an association between albumin levels and AKI. Whether hypoalbuminemia and neonatal AKI are associated has not been studied. Methods: We evaluated the association of albumin with early (during the first postnatal week) and late (after the first postnatal week) AKI for 531 neonates from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database and for 3 gestational age (GA) subgroups: < 29, 29 to < 36, and ≥ 36 weeks GA. Results: Low albumin levels were associated with increased odds of neonatal AKI; for every 0.1 g/dL decrease in albumin, the odds of late AKI increased by 12% on continuous analysis. After adjustment for potential confounders, neonates with albumin values in the lowest quartiles (< 2.2 g/dL) had an increased odds of early [Adjusted Odd Ratio (AdjOR) 2.5, 95% CI = 1.1–5.3, p < 0.03] and late AKI [AdjOR 13.4, 95% CI = 3.6–49.9, p < 0.0001] compared to those with albumin in the highest quartile (> 3.1 g/dL). This held true for albumin levels 2.3 to 2.6 g/dL for early [AdjOR 2.5, 95% CI = 1.2–5.5, p < 0.02] and late AKI [AdjOR 6.4, 95% CI = 1.9–21.6, p < 0.01]. Albumin quartiles of (2.7 to 3.0 g/dL) were associated with increased odds of late AKI. Albumin levels of 2.6 g/dL and 2.4 g/dL best predicted early (AUC = 0.59) and late AKI (AUC = 0.64), respectively. Analysis of albumin association with AKI by GA is described. Conclusions: Low albumin levels are independently associated with early and late neonatal AKI. Albumin could be a potential modifiable risk factor for neonatal AKI.
AB - Background: Data from adult and pediatric literature have shown an association between albumin levels and AKI. Whether hypoalbuminemia and neonatal AKI are associated has not been studied. Methods: We evaluated the association of albumin with early (during the first postnatal week) and late (after the first postnatal week) AKI for 531 neonates from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database and for 3 gestational age (GA) subgroups: < 29, 29 to < 36, and ≥ 36 weeks GA. Results: Low albumin levels were associated with increased odds of neonatal AKI; for every 0.1 g/dL decrease in albumin, the odds of late AKI increased by 12% on continuous analysis. After adjustment for potential confounders, neonates with albumin values in the lowest quartiles (< 2.2 g/dL) had an increased odds of early [Adjusted Odd Ratio (AdjOR) 2.5, 95% CI = 1.1–5.3, p < 0.03] and late AKI [AdjOR 13.4, 95% CI = 3.6–49.9, p < 0.0001] compared to those with albumin in the highest quartile (> 3.1 g/dL). This held true for albumin levels 2.3 to 2.6 g/dL for early [AdjOR 2.5, 95% CI = 1.2–5.5, p < 0.02] and late AKI [AdjOR 6.4, 95% CI = 1.9–21.6, p < 0.01]. Albumin quartiles of (2.7 to 3.0 g/dL) were associated with increased odds of late AKI. Albumin levels of 2.6 g/dL and 2.4 g/dL best predicted early (AUC = 0.59) and late AKI (AUC = 0.64), respectively. Analysis of albumin association with AKI by GA is described. Conclusions: Low albumin levels are independently associated with early and late neonatal AKI. Albumin could be a potential modifiable risk factor for neonatal AKI.
KW - Hypoalbuminemia
KW - Infants
KW - Kidney failure
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85127362402&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127362402&partnerID=8YFLogxK
U2 - 10.1007/s00467-021-05295-2
DO - 10.1007/s00467-021-05295-2
M3 - Article
C2 - 34657971
AN - SCOPUS:85127362402
SN - 0931-041X
VL - 37
SP - 1675
EP - 1686
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 7
ER -