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Abstract: SA-OR009

Does Erythropoietin (Epo) Protect Extremely Low Gestational Age Neonates (ELGANs) Against AKI?

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Askenazi, David J., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Schmicker, Robert, University of Washington Center for Biomedical Statistics, Seattle, Washington, United States
  • Griffin, Russell, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Heagerty, Patrick James, University of Washington, Seattle, Washington, United States
  • Brophy, Patrick D., University of Rochester, Rochester, New York, United States
  • Juul, Sandra, University of Washington, Seattle, Washington, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Hingorani, Sangeeta R., Seattle Children’s Hospital, Seattle, Washington, United States

Group or Team Name

  • PENUT Investigators
Background

The Recombinant Erythropoietin for Protection of Infant Renal Disease (REPAIReD) study is a randomized, placebo-controlled study designed to test the hypothesis that infants randomized to Epo will have lower rates of severe AKI than placebo-treated infants. Secondary outcomes include severity of AKI, AKI at different timepoints (postnatal days 3-7, days 8-14, and days >14), and SCr/Cystatin C values at 7, 9 and 14 postnatal days.

Methods

936 infants were randomized to Epo vs. placebo. Those who died on days 0, 1, 2 are excluded (n=13) leaving 923 for analysis. Infants recevied EPO 1000 U/kg or placebo IV every other day x 6 doses and then Epo 400 U/kg SQ or sham infections every Monday, Wednesday and Friday until 33 weeks post-menstrual age. AKI is defined by the Neonatal KDIGO classification using the lowest prior SCr as the baseline value. As the first postnatal days reflect maternal SCr, day 3 was first possible AKI day. Severe AKI was defined as doubling of SCr from baseline (stage 2 or 3 AKI). GEE models including gestational age, sex, site and sibship clustering were used for analysis of our primary outcome.

Results

No maternal or neonatal differences by treatment group were observed. 374/923 (40.5%) had at least one epidose of AKI, of which 191/ 374 (51%) had severe AKI. We found no differences in the rates of severe AKI between treatment groups (Figure 1). GEE models showed no differences in severe AKI rates between treatment groups after controlling for potential confounders (OR [95%CI] = 0.75 [0.53, 1.06]). No difference between treatment groups was seen in our secondary outcomes.

Conclusion

Up to 40% of ELGANS have at least one episode of Neonatal AKI. Epo is not protective for AKI in ELGANS. Whether Epo impacts urine kidney biomarkers or long-term CKD remains an area of investigation.

Funding

  • NIDDK Support