216 - Perinatal Risk Factors for Early and Late Severe Acute Kidney Injury Among Extremely Low Gestational Age Newborns: a secondary analysis of the Preterm Erythropoietin Neuroprotection Trial

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 216
Publication Number: 216.242

Keia Sanderson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Nekayla Anderson, UAB, Birmingham, AL, United States; Russell Griffin, University of Alabama at Birmingham, Birmingham, AL, United States; Andrew M.. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Jonathan R. Swanson, University of Virginia School of Medicine, Charlottesville, VA, United States; Michael Zappitelli, The Hospital for Sick Children, Toronto, ON, Canada; Heidi J.. Steflik, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Marissa JANEL. DeFreitas, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Jennifer R. Charlton, University of Virginia, Charlottesville, VA, United States; David Askenazi, University of Alabama at Birmingham, BIRMINGHAM, AL, United States

Presenting Author(s)

KS

Keia Sanderson, MD, MSc

Assistant Professor of Medicine and Pediatrics
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina, United States

Background: Acute kidney injury (AKI) is common among Extremely Low Gestational Age Newborns (ELGANs, < 28 weeks gestation), and is associated with increased mortality but perinatal risk factors for AKI in this population are not well defined.

Objective: The objective of this study was to describe the perinatal risk factors for severe AKI within the first 7 postnatal days (“early severe AKI”) and after 7 postnatal days (“late severe AKI”).

Design/Methods: This was a secondary analysis of the Preterm Epo Neuroprotection Trial study, a multi-center randomized clinical trial of erythropoietin in ELGANs. Infants who died or transferred prior to the first 7 days of life were excluded. Severe AKI was defined using the modified Kidney Disease: Improving Global Outcomes stage 2-3 neonatal AKI criteria by serum creatinine (SCr). The baseline SCr was established as the lowest SCr after 24-48 hours of life.

Crude and adjusted Cox proportional hazards models stratified by gestational age were conducted using time-dependent exposures which occurred within 72 hours prior to early and late, severe AKI.

Exposure variables with alpha threshold of 0.1 on univariate analysis were selected for the models.

Early severe AKI exposures included maternal age, maternal gestational diabetes, delivery type, birth weight, and any non-steroidal anti-inflammatory drug (NSAID), vancomycin, or diuretic exposure within 72 hours prior to early severe AKI onset.

Late severe AKI exposures included prior severe AKI, spontaneous intestinal perforation, PDA surgery, sepsis, and any vasopressor, vancomycin, gentamicin, or diuretic exposures within 72 hours prior to severe AKI onset.

Results:

Of the 923 participants who met criteria, 20 (2.2%) had early severe AKI. In the adjusted model maternal gestational diabetes (adjusted HR 5.36; 95% 1.1-25.8), NSAID (aHR 3.2; 95% CI 1.0-9.8), and vancomycin exposure (aHR 13.92; 95% CI 4.3-45.1) had a greater risk for early severe AKI (Table 1).
Fifty infants (5.4%) transferred or died within the first 7 postnatal days. One hundred fifty-seven (18%) of 873 surviving infants had late severe AKI. Infants with early severe AKI (aHR 1.58; 95% CI 1.0-2.0), sepsis (aHR 1.84; 95% CI 1.0-3.3), vasopressor (aHR 2.89; 95% CI 1.91-4.38), and diuretic exposures (aHR 2.66; 95% CI 1.9-3.6) had a greater risk for late severe AKI (Table 2).

Conclusion(s): Awareness of early and late severe AKI risk factors could support electronic health record clinician alerts for kidney monitoring recommendations and enrich future studies exploring interventions to improve infant kidney outcomes.