TABLE 2.
Epidemiology of high risk populations for neonatal acute kidney injury.
| NICU sub-population | Study details | AKI incidence | Significant findings |
| Premature and low birth weight (LBW) neonates | Hingorani et al. (n = 900) (14) | 19% severe AKI† | • Stage 3: AKI occurring 7 days before death independently associated with death • Severe AKI associated with increased hazard of death |
| Askenazi et al. (n = 923) (13) | 38% | • 18% had 1 episode of severe† AKI • Rates of severe† AKI: ° 24 weeks GA: 27.8% ° 25 weeks GA: 21.9% ° 26 weeks GA: 13.6% ° 27 weeks GA: 9.4% • AKI rates significantly higher with decreasing GA and BW |
|
| Lee et al. (n = 276) (15) |
56% (Stage 1: 30%; Stage 2: 17%; Stage 3: 9%) |
• High-frequency ventilation support, PDA, lower GA, and inotropic agent utilization independently associated with AKI • Maternal pre-eclampsia is protective against neonatal AKI • AKI associated with higher mortality before 36 weeks PMA |
|
| Carmody et al. (n = 455) (20) | 39.8% (16.5% multiple episodes) |
• GA < 28 weeks’ associated with AKI • AKI independently associated with increased mortality and increased length of hospital stay |
|
| Koralkar et al. (n = 229) (87) | 18% | • AKI was independently associated with increased mortality | |
| Askenazi et al. (n = 195) (88) | Case–control study | ||
| Congenital heart disease (CHD) and cardiac surgery |
Sasaki et al. (n = 582) (89) |
38% | • AKI prevalence peaked on post-operative day 1 (17%) • No stage of AKI was associated with ventilation hours or length of stay |
| Alten et al. (n = 22,400) (26) |
CS-AKI 53.8% (Stage 1: 31%; Stage 2: 13.5%; Stage 3: 9.1%) |
• CS-AKI varied greatly across institutions • Pre-operative enteral feeding and open sternum were associated with less CS-AKI • CPB was associated with increased CS-AKI • Stage 3: CS-AKI independently associated with mortality |
|
| Alabbas et al. (n = 122) (90) | 62% | • Severe AKI (stage 3) was independently associated with increased mortality and length of stay | |
| Blinder et al. (n = 430) (22) | 52% (Stage 1: 31%; Stage 2: 14%; Stage 3: 7%) |
• Single ventricle status, CPB, and higher reference SCr were associated with post-operative AKI • Post-operative AKI (all stages) associated with longer intensive care stay • More severe AKI associated with in-hospital mortality, longer duration of mechanical ventilation, longer duration of inotropic support • Stage 3: AKI associated with systemic ventricular dysfunction at hospital discharge |
|
| Hypoxic ischemic encephalopathy (HIE) | Kirkley et al. (n = 113) (91) | 41.6% | • Outside hospital birth, IUGR, and meconium at delivery associated with increased odds of AKI • Infants with AKI had longer duration of stay compared to those without AKI |
| Chock et al. (n = 38) (92) | 39% | • Those with AKI had higher renal artery saturations (Rsat; via NIRS) compared to those without AKI after 24 h of life • Rsat > 75% by 24–48 h predicted AKI with sensitivity 79% and specificity 82% (AUC 0.76) |
|
| Tanigasalam et al. (n = 120) (35) | 32% in TH; 60% in standard tx |
AKI incidence in TH vs. standard tx groups: • Stage 1: 22 vs. 52% • Stage 2: 5 vs. 5% • Stage 3: 5 vs. 3% |
|
| Sarkar et al. (n = 88) (33) | 39% | • AKI independently associated with abnormal brain MRI | |
| Selewski et al. (n = 96) (28) | 38% | • AKI predicted prolonged duration of mechanical ventilation and length of stay | |
| Necrotizing enterocolitis (NEC) | Garg et al. (n = 202) (36) | 32.6% severe AKI NEC dx; 58.7% after surgical NEC | • Surgical NEC, outborn status, exposure to antenatal steroids, and positive blood culture sepsis had increased odds of severe AKI • Severe AKI associated with longer duration of hospitalization |
| Bakhoum et al. (n = 77) (39) | 42.9% (Stage 1: 18.2%; Stage 2: 13%; Stage 3: 11.7%) |
• Bell’s stage II NEC with AKI: 63.6% • Bell’s stage III NEC with AKI: 36.4% • Bell’s Stage III NEC, lower GA, maternal pre-eclampsia/eclampsia, gentamicin/vancomycin exposure, and empiric antibiotic use independently associated with AKI • AKI independently associated with mortality |
|
| Criss et al. (n = 181) (38) | 54% (Stage 1: 22%; Stage 2: 18%; Stage 3: 16%) |
• Neonates with AKI had higher mortality and higher chance of death | |
| Nephrotoxic medications (NTX) | Salerno et al. (n = 8,286) (43) | 17% | • Sepsis, lower baseline SCr, and duration of combination therapy were associated with increased odds of AKI • [Furosemide + tobramycin] and [vancomycin + piperacillin-tazobactam] were associated with decreased risk of AKI relative to [gentamicin + indomethacin] |
| Rhone et al. (n = 107) (42) | Infants with AKI received more NTX per than those without AKI | • Exposure to 1 NTX occurred in 87% of VLBW infants ° Gentamicin: 86% ° Indomethacin: 43% ° Vancomycin: 25% • Inverse relationship between BW and NTX received per day |
|
| Extracorporeal Life support (ECLS) | Murphy et al. (n = 446) (49) | 51% | • AKI most common in those with cardiac disease but varies by underlying diagnosis • Risk of mortality differed by diagnostic category in the presence or absence of AKI ° Without AKI, CDH independently predicts mortality |
| Fleming et al. (n = 832) (48) | 74% | • AKI during ECLS was associated with longer duration of ECLS support and increased adjusted odds for mortality | |
| Zwiers et al. (n = 242) (45) | 64% | • Increased risk of mortality at highest stage of AKI |
NICU, neonatal intensive care unit; AKI, acute kidney injury; GA, gestational age; BW, birth weight; PDA, patent ductus arteriosus; PMA, post menstrual age; CS-AKI, cardiac surgery-associated AKI; CPB, cardiopulmonary bypass; SCr, serum creatinine; IUGR, intrauterine growth restriction; Rsat, renal saturations; NIRS, near-infrared spectroscopy; AUC, area under the curve; TH, therapeutic hypothermia; MRI, magnetic resonance imaging; NEC, necrotizing enterocolitis; NTX, nephrotoxic medication; CDH, congenital diaphragmatic hernia; ECLS, extracorporeal life support; tx, treatment. †Severe AKI defined as = stage 2 AKI.