Kidney Week

Abstract: SA-PO0681

Elevated Serum Creatinine over the First Week of Life and Mortality Risk in Extremely Premature Neonates: Secondary Analysis of the Preterm Erythropoietin Neuroprotection Trial (PENUT)

Session Information

• Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Zhou, Melissa S., Stanford University School of Medicine, Palo Alto, California, United States

Melissa S. Zhou, MD

• Griffin, Russell, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Russell Griffin

• Chock, Valerie, Stanford University School of Medicine, Palo Alto, California, United States

Valerie Chock, MD

• Menon, Shina, Stanford University School of Medicine, Palo Alto, California, United States

Shina Menon, MD, FASN

Background

The neonatal-modified Kidney Disease: Improving Global Outcomes AKI definition based on serum creatinine (SCr) (KDIGO-AKI) may misclassify extremely low gestational age neonates (ELGANs) with high initial SCr or delayed SCr decline within the first week of life (Week 1). We evaluated whether gestational age (GA) and day of life-specific SCr thresholds over Week 1 could identify additional ELGANs at risk for mortality.

Methods

Secondary analysis of the prospective PENUT Trial of ELGANs born at <28 weeks GA. Daily 95^th percentile SCr thresholds over Week 1 were derived from ELGANs without KDIGO-AKI for 2 GA groups, 24-25 and 26-27 weeks. The primary exposure, 95^th-AKI, defined as ≥1 SCr above GA-based thresholds during Week 1, was compared to KDIGO-AKI and no AKI. Time varying Cox proportional hazard models adjusted for selected significant variables were used to examine the association between AKI status and in-hospital mortality (primary outcome).

Results

Among 918 ELGANs, 72 (8%) had 95^th-AKI and 106 (12%) KDIGO-AKI in Week 1. Neonates with 95th-AKI were more often born to mothers with hypertension, pre-eclampsia, or non-Hispanic ethnicity. KDIGO-AKI was associated with younger maternal age, lower GA, and higher rates of surfactant and NSAID use. Both AKI groups had lower birthweight and higher vasopressor exposure than no AKI group (p<0.05). Mortality was higher with 95^th-AKI or KDIGO-AKI than no AKI (p=0.003). Compared to no AKI in Week 1, after adjustment for GA, vasopressor or NSAID exposure, 95^th-AKI was associated with increased mortality [adjusted HR 2.43, 95% CI 1.29-4.58] whereas KDIGO-AKI was not (adjusted HR 1.16, 95% CI 0.60-2.24) (Figure 1).

Conclusion

Elevated SCr in Week 1 without meeting the KDIGO definition is independently associated with mortality in ELGANs. Gestational age and day of life-specific SCr thresholds may offer a more sensitive approach to identify at-risk neonates.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025p9t3m42e