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Kidney Week

Abstract: TH-OR124

Effect of Erythropoietin (Epo) on Outcomes at 24-26 Months in Extremely Low Gestational Age Neonates (ELGAN)

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Hingorani, Sangeeta R., Seattle Children’s Hospital, Seattle, Washington, United States
  • Schmicker, Robert, University of Washington Center for Biomedical Statistics, Seattle, Washington, United States
  • Ahmad, Kaashif A., MEDNAX National Medical Group, San Antonio, Texas, United States
  • Gilmore, Maureen M., Johns Hopkins University, Baltimore, Maryland, United States
  • Lagamma, Edmund F., New York Med College - Maria Fareri Children''s Hosp, Valhalla, New York, United States
  • Juul, Sandra, University of Washington, Seattle, Washington, United States
  • Askenazi, David J., University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Changes in EPO in premature infants may have a critical role in glomerulogenesis.The REPAIReD study examines kidney outcomes of ELGANS enrolled in PENUT, a randomized placebo-controlled trial of Epo. We compare prevalence and risk factors of chronic kidney disease (CKD), albuminuria, and hypertension at 24 months corrected gestational age (cGA) by treatment group.

Methods

Patients who survived to 24-26 months cGA with blood, urine or blood pressure at follow-up were included. We defined CKD as estimated glomerular filtration rate (eGFR) via the Schwartz cystatin C equation <90 ml/min/1.73m2; hypertension as either systolic blood pressures (SBP) or diastolic (DBP) > 95%ile for height, age and gender; and albuminuria as a urine albumin/creatinine ratio ≥ 30 mg/g. Associations between baseline characteristics, maternal race and pre-eclampsia, and outcomes were assessed.

Results

778 (84%) of enrolled babies had a 24-26 month follow up visit. 54 (16%) had an eGFR < 90mL/min/1.73m2, 155 (36%) had albuminuria, 119 (24%) had systolic hypertension and 163 (33%) had diastolic hypertension. We found no difference by treatment group. An eGFR <90 was associated with lower birthweight (p<0.001), small for gestational age (p<0.05) and pre-eclampsia (p<0.05).

Conclusion

A low GFR, albuminuria, and hypertension are common in ELGANS and present at 24-26 months of age. Long-term kidney follow up of all premature infants less than 28 weeks GA is needed starting at 2 years old.

Table 1. Baseline characteristics and 24-month follow-up by treatment arm
 PlaceboEpo Treatment
Gestational age, n (%)
24 weeks
25 weeks
26 weeks
27 weeks
117 (25.8%)
122 (26.9%)
117 (25.8%)
98 (21.6%)
110 (23.5%)
120 (25.6%)
103 (22.0%)
136 (29.0%)
Alive at hospital discharge, n (%)410 (90.3%)418 (89.1%)
24-month follow-up conducted, n (%)395 (87.0%)383 (81.7%)
24 mo height/weight available, n (%)
Weight kg, mean (sd)
Height cm, mean (sd)
358 (78.9%)
11.4 (1.7)
84.5 (4.5)
344 (73.3%)
11.3 (1.9)
85.1 (4.8)
24 mo blood collected, n (%)190 (41.9%)170 (36.2%)
24 mo urine collected, n (%)218 (48.0%)227 (48.4%)
eGFR value available, n (%)
Median mL/min/1.73m2 (IQR)
<90 mL/min/1.73m2, n (%)
179 (39.4%)
101.3 (93.8, 113.8)
29 (16.2%)
157 (33.5%)
102.7 (96.6, 112.7)
25 (15.9%)
Alb/Creat ratio available, n (%)
Median mg/g (IQR)
≥30 mg/g, n (%)
212 (46.7%)
21.8 (13.4, 37.7)
78 (36.8%)
223 (47.5%)
22.0 (14.3, 38.2)
77 (34.5%)
eGFR and Alb/Creat ratio available, n (%)
eGFR≥90 and/or Alb/Creat<30, n (%)
eGFR<90 and Alb/Creat≥30, n (%)
131 (28.9%)
125 (95.4%)
6 (4.6%)
114 (24.3%)
104 (91.2%)
10 (8.8%)
Hypertension value available, n (%)258 (56.8%)234 (49.9%)
SBP >=95th %ile, n (%)70 (27.1%)49 (20.9%)
Median SBP (IQR)98.5 (90, 106.75)97 (90, 104)
DBP >=95th %ile, n (%)87 (33.7%)76 (32.5%)
Median DBP (IQR)58.0 (52.0, 65.8)58.0 (50.0, 66.0)

Funding

  • NIDDK Support