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Abstract: TH-OR123

Low Albumin Is Associated with Neonatal AKI During the First Post-Natal Week of Life: Report from the AWAKEN Study Group

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology


  • Nada, Arwa, LeBonheur Children's Hospital , Memphis, Tennessee, United States
  • Li, Linzi, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Griffin, Russell, University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Kupferman, Juan C., Maimonides Medical Center, Brooklyn, New York, United States
  • Mhanna, Maroun J., Metro Health Medical Center, Cleveland, Ohio, United States
  • Mahan, John D., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Askenazi, David J., University of Alabama at Birmingham, Birmingham, Alabama, United States

Group or Team Name

  • On Behalf of the Neonatal Kidney Collaborative

Hypoalbuminemia is an established risk factor for morbidity and mortality in adults and children. Adult studies showed an association between low albumin (alb) and acute kidney injury (AKI) in different settings. Low alb was found to be associated with AKI in children undergoing cardiac surgery. In this analysis of newborns (NB) enrolled in the Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) we hypothesize that low alb is associated with increased risk of AKI in the first postnatal week of life. To our knowledge, this is the first study to examine this relationship in NB


AWAKEN included 2162 NB admitted to the neonatal intensive care units at 24 institutions (4 countries) from 01/14-03/14. Inclusion criteria: intravenous fluids for ≥48 hrs. Exclusion criteria: congenital heart disease repair at <7 days of life, lethal anomaly or death at ≤48 hrs. For this analysis, we excluded 1461 NB who had no alb levels documented,19 NB who didn't have at least 2 serum creatinines or at least one day of urine output recorded during first postnatal week. Analysis was done for the entire cohort and for 3 stratified groups; <29 weeks (wks), ≥29 to <36 wks and ≥36 wks gestational age (GA)


A total of 682 babies were included, 47.8% had at least 1 episode of AKI. Table 1 shows that mean minimum alb was significantly lower in AKI group versus the no-AKI group (p < 0.0001) for the entire cohort and for each of the 3 stratified groups. Mean maximum Alb was higher in the no-AKI group versus the AKI group (p= 0.0001) for the entire cohort and for the <29 wks and ≥39 wks groups. Low alb levels were independently associated with AKI. For every 1 g/dL decrease in alb the odds of developing AKI increased by 4%. Even after adjusting for confounders including fluid status; for every alb of 1 there was 4.6% higher odds of having AKI


AWAKEN describes for the first time the association between low alb and AKI in the first postnatal week. This association remained regardless of fluid balance and other potential confounders

Table 1: Mean and SD of Minimum and Maximum Albumin Levels Among Studied Groups
 Whole Group
GA< 29 weeks
n= 99
GA ≥29<36
GA≥36 weeks
n= 346
n= 356
n= 326
p-valueNo AKI
n= 41
n= 58
p-valueNo AKI
n= 145
n= 92
p-valueNo AKI
n= 170
n= 176
Minimum albumin2.7±0.62.4±0.6< 0.00012.6±0.52.2±0.60.0012.7±0.52.4±0.60.0012.8±0.62.5±0.7<0.0001
Maximum albumin3.0±0.52.8±0.70.00012.8±0.52.5±0.60.0032.9±0.52.9±0.70.793±0.62.9±0.70.004