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Abstract: PO1954

Neonatal AKI Is Associated with Impaired Renal Function at 24 Months of Age

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Krom, Stephanie C., University of Rochester Medical Center, Rochester, New York, United States
  • Kent, Alison, University of Rochester Medical Center, Rochester, New York, United States
  • Rademacher, Erin, University of Rochester Medical Center, Rochester, New York, United States
  • Wang, Hongyue, University of Rochester Medical Center, Rochester, New York, United States
Background

Neonatal acute kidney injury (nAKI) is common, occurring in up to 30% of neonatal intensive care admissions. However, there are currently no guidelines for nephrologic evaluation after the neonatal period. Our objective was to determine the incidence of renal dysfunction at 24-months of age and to identify associated risk factors following nAKI.

Methods

Retrospective single-center cohort study of infants with nAKI (defined as rise in creatinine (Cr) ≥ 0.3, abnormal initial Cr for gestational age, or abnormal rate of Cr decline) seen in pediatric nephrology clinic at 24-months. Abnormal estimated glomerular filtration rate (eGFR) (< 90 ml/min/1.73m2), hypertension (BP ≥ 95th%ile), proteinuria (TP/Cr > 0.5), and renal length (≥ the 95th or ≤ the 5th %ile) were correlated with high risk NICU events and exposures. Data was obtained by chart review. eGFR was calculated using cystatin C and creatinine separately, using the CKID cystatin C and the revised Schwartz equations, respectively. Data was analyzed using t-tests, Wilcoxon Rank Sum Test, or Chi-square as appropriate.

Results

36/42 infants with history of nAKI referred to nephrology had a 24-month visit. 20 of 36 subjects (55.5%) had at least one renal abnormality, with 14 (39%) having eGFR < 90 ml/min/1.73m2 by cystatin C, 7/36 (19.4%) had proteinuria, 3/36 (8.3%) had hypertension, and 4/36 (11.1%) had abnormal renal length. 1/15 subjects with reduced GFR by cystatin C also had a reduced GFR by serum creatinine. Subjects with renal dysfunction at 24 months had a neonatal history of more vasopressors exposure days (mean, 4.5 vs 0.25, p = 0.002), more total diuretic days (mean 122 vs 51 p=0.03), were more likely to be taking a diuretic at discharge (n=11 vs n=3, p= 0.026), or to be of extremely low birth weight (ELBW < 1000 gm) (n=14 vs n=4, p= 0.007) compared to those without renal dysfunction.

Conclusion

The majority of children with nAKI had evidence of renal dysfunction at 24-month of age. Serum Cystatin C was more sensitive at identifying kidney dysfunction than creatinine alone. All children with nAKI should be referred for renal follow-up with a particular focus on children who were ELBW, required vasopressors, or had prolonged diuretic use in the neonatal period.