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Kidney Week

Abstract: PO1955

Kidney Outcomes Among Extremely Preterm Born Adolescents with Neonatal AKI

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Lupo, Ryan, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Chang, Emily H., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Bjornstad, Erica C., The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • O'Shea, Michael, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Sanderson, Keia, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
Background

Infants born preterm are at increased risk for neonatal acute kidney injury (nAKI). AKI increases the risk for CKD long term however, long term kidney outcomes among preterm born survivors of nAKI are not well known.The aim of the study is to evaluate associations between nAKI and microalbuminuria, elevated blood pressure (BP), and reduced kidney mass in adolescents born extremely preterm.

Methods

We obtained 2 manual BPs, a random urinalysis, and kidney ultrasound on adolecents of the University of North Carolina ELGAN (Extremely Low Gestational Age Newborn) cohort between 2017-2019. We retrospectively obtained serum creatinine (SCr) studies from the initial neonatal intensive care unit hospitalization between 2002-2004. We defined nAKI by neonatal KDIGO guidelines.

Results

Of the 31 participants born <28 weeks gestation, mean age was 15.2 years and 58% were overweight/obese. 32% of adolescents had elevated BP, 13% had reduced kidney mass, and 13% microalbuminuria. 52% of the adolescents had a history of nAKI. 81% experienced Stage 1 AKI, 19% had Stage 2 AKI, and no participants experienced Stage 3 AKI. Those with nAKI had lower birth weight, lower APGAR scores, more mechanical ventilator days, lower urine output, greater vasopressor exposure, greater indomethacin exposure, less methylxanthine exposure, greater # of serum SCr measurements, and more days in the hospital. During adolescence, those with nAKI had lower frequency of elevated BP and microalbuminuria but greater frequency of reduced kidney mass(Table 1).

Conclusion

Adolescents with a history of nAKI were more frequently exposed to nephrotoxic factors and had more indicators of severe illness in early life. However, nAKI was not significantly associated with elevated BP, microalbuminuria, or kidney mass in this sample of adolescents born extremely preterm. Further follow up is needed to better characterize manifestation of CKD in adolescents after nAKI.

Table 1
 With Neonatal AKI
(n=16)
Without Neonatal AKI
(n=15)
Birth characteristics collected 2002–2004
Gestational Age at Birth (weeks), mean(SD)
Birth Weight (grams), mean(SD)
APGAR 1 minute, md(IQR)
APGAR 5 minute, md(IQR)
Mechanical Ventilator Days, md (IQR)
Urine Output (ml/kg/hr), md (IQR) δ
Use of Vasopressors in first 14 days of life, n(%)
Indomethacin exposure in first 28 days, n(%)
# of Methylxanthine doses in first 28 days, md (IQR)
Age at initial AKI (days), md (IQR)
# of AKI episodes, mean(SD)
Total # of serum creatinines measured, md (IQR)
Discharge serum creatinine, mean(SD)
Duration of NICU Course (weeks), mean(SD)
25.4 (±0.9)
776.6 (±184.3)
2.5 (2,5)
5.5 (5,7)
27.5 (16,28)
1.0 (0.4, 1.6)
12 (75)
10 (62.5)
3.5 (0, 9.5)
7 (2.5, 11)
1 (1, 1.5)
17.5 (12, 21.5)
0.35 (±0.17)
15.1 (±7.7)
26.1 (±1.1)
790 (±176.6)
6 (3,7)
8 (7,9)
8 (3,25)
1.8 (1.5, 2.6)
6 (40)
5 (33.3)
17 (10, 25)
----
----
11 (8,13)
0.47 (±0.23)
9.9 (±3.9)
Ancillary 15-Year Old Kidney Study Visit Characteristics Collected 2017-2019
Age (years), med (IQR)
Males, n(%)
BMI >85th percentile, n(%)
Elevated Blood Pressure (>120/80mmHg), n(%)
Systolic Blood Pressure (mmHg), mean(SD)
Diastolic Blood Pressure (mmHg), mean(SD)
Renal Hypoplasia**, n(%)
Total kidney volume/body surface area, mean(SD)
Microalbuminuria (>30µg/g), n(%)
Urine Albumin/Creatinine (µg/g), md(IQR)
Composite Kidney Outcome, n(%)
15.1 (±0.2)
9 (56.3)
9 (56.3)
3 (18.8)
114.1 (±8.3)
65.8 (±6.9)
3 (18.8)
125.9 (±23.1)
1 (6.3)
6.6(4.3, 11.8)
10 (62.5)
15.3 (±0.4)
10 (66.7)
9 (60)
7 (46.7)
115.7 (±8.8)
72.1 (±8.2)
1 (6.7)
136 (±34.5)
3 (20)
12.5 (5.4,26.4)
5 (33.3)

δUrine output in the first 12 hours of life; **Renal hypoplasia defined by body surface area related total kidney volume below the 10th percentile of normative TKV/BSA [1, 2]