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Kidney Week

Abstract: FR-PO030

Underrecognition of Neonatal AKI and Lack of Follow-up

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Roy, Jean-Philippe, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Schuh, Meredith Posner, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Recent data show an incidence of 30% of acute kidney injury (AKI) in neonatal intensive care units (NICU). AKI is associated with increased mortality and risk of chronic kidney disease (CKD) in children. To assess the follow-up of these patients (pt) and early CKD signs, we retrospectively reviewed long-term outcomes of Cincinnati Children’s Hospital Medical Center (CCHMC) cohort of neonates included in the AWAKEN trial (2014).

Methods

81 CCHMC pt were extracted from AWAKEN data. KDIGO criteria for serum creatinine (SCr) and urine output (UOP) < 1 mL/kg/h, reported per 24h on post-natal days 2-7, were used to define AKI. Charts were reviewed until May 2019 for pt death, inpatient nephrology consult, AKI diagnosis on discharge summary, follow-up anywhere at CCHMC, as well as potential early CKD signs at > 6 months of age and after AKI (defined as any one of an estimated GFR (eGFR) by Schwartz < 90 ml/min/1.73m2, hyperfiltration, proteinuria, hypertension, or abnormal ultrasound). Pt were considered to have a renal follow-up if they had at least one visit anywhere in that timeframe with at least one of the following: SCr, urinalysis or a blood pressure measurement.

Results

77 pt had sufficient data to ascertain an AKI diagnosis. 47/77 (61%) were AKI+ by either SCr or UOP criteria (13 stage 3, 14 stage 2 and 20 stage 1). Of those, 4 died during their initial admission (2 AKI- and 2 AKI+, stage 1 and 2) and 5 pt with significant urologic anomalies were removed from the CKD analyses. Taken separately, AKI-UOP alone outnumbered AKI-SCr (respectively 45 AKI+ vs 5 AKI+ for all stages, 10 and 27 pt with insufficient data for AKI ascertainment). 33% of pt had < 2 SCr measured in the NICU. Only 3/47 AKI+ pt had a nephrology consult (all stage 3 by SCr) and 2/47 had AKI reported on their discharge summary. 67% of AKI+ pt had some form of renal follow-up. 10/43 (23%) AKI+ vs 12/25 (48%) AKI- pt had ≥1 marker of early CKD signs measured after 6 months. Only hyperfiltration was positive in 3/7 (43%) AKI+ vs 0/7 (0%) AKI- pt with SCr available (p=0.19). Median eGFR in AKI+ pt was 120 vs 126 ml/min/1.73m2 for AKI- (p=0.46).

Conclusion

AKI is vastly under-recognized in the NICU, especially if based on SCr alone. This leads to insufficient follow-up to ascertain renal sequelae in this high risk population despite a trend toward more hyperfiltration.