Kidney Week

Abstract: TH-OR099

AKI in Neonates in the Modern Era: Preliminary Results from the Multinational AWAKEN 2.0 Cohort

Session Information

• Shaping Pediatric Kidney Disease: Developmental Insights, Stem Cell Systems, Novel Biomarkers, and More
  October 22, 2026 | Location: Room 603, Convention Center
  Abstract Time: 05:50 PM - 06:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Starr, Michelle C., Indiana University School of Medicine, Indianapolis, Indiana, United States

Michelle C. Starr, MD, MPH, FASN

• Kumar, Hanush, Indiana University School of Medicine, Indianapolis, Indiana, United States

Hanush Kumar, MS

• Baeta Baptista, Rute, Indiana University School of Medicine, Indianapolis, Indiana, United States

Rute Baeta Baptista, MD

• Askenazi, David J., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

David J. Askenazi, MD, MS, FASN

• Charlton, Jennifer R., University of Virginia School of Medicine, Charlottesville, Virginia, United States

Jennifer R. Charlton, MD, MS

• Forbes, Thomas A., Murdoch Children's Research Institute, Parkville, Victoria, Australia

Thomas A. Forbes, MBBS, PhD

• Harer, Matthew W., University of Wisconsin-Madison, Madison, Wisconsin, United States

Matthew W. Harer, MD

• Sanderson, Keia, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Keia Sanderson, MD, MS

• Slagle, Cara L., Indiana University School of Medicine, Indianapolis, Indiana, United States

Cara L. Slagle, MD

• Selewski, David T., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

David T. Selewski, MD, MS, FASN

Group or Team Name

• AWAKEN 2.0 Collaborative Study Group

Background

Neonatal acute kidney injury (AKI) is associated with increased mortality and prolonged neonatal intensive care unit (NICU) admission. Since the original AWAKEN study, AKI definitions and practices have evolved. We aimed to determine incidence and outcomes associated with neonatal AKI using the 2026 KDIGO criteria in a multinational cohort.

Methods

In this multicenter, multinational, retrospective cohort, neonates admitted to NICUs 1/1-3/31/19 were screened. Eligible neonates received intravenous fluids >48h. Exclusion criteria: admission ≥14d, congenital heart disease with surgery within 7d, lethal chromosomal anomalies, or death within 48h. AKI was defined according to the 2026 neonatal KDIGO criteria (increase in SCr ≥0.3mg/dL [26.5umol/L] within 48h, SCr ≥1.5x baseline within 7d, or urine output. AKI severity was staged using either creatinine or urine output. Multivariable models were used to evaluate associations between AKI and mortality and length of stay after adjustment for gestational age, birth weight, illness severity, and center.

Results

Of the 2,134 infants included in this preliminary analysis (27 of 106 enrolling sites, 8 countries), 1,972 had sufficient data to determine AKI status. Of those, 461 (23.4%) developed AKI. AKI incidence varied by gestational age: <29 weeks 40.9% (115/281); ≥29 to <36 weeks 15.6% (123/786); and ≥36 weeks 24.6% (223/907). Stage distribution: stage 1 AKI in 238 (12.1%), stage 2 in 112 (5.7%), and stage 3 in 111(5.6%) infants. Infants with AKI had higher mortality compared with those without AKI (53/461 [11.5%] vs 22/1511 [1.5%]; aOR 6.41, 95% CI 3.54–11.93; p<0.0001). AKI was independently associated with longer NICU stay (adjusted parameter estimate 19.3 days, 95% CI 10.82–27.85; p<0.0001). Additional analyses between AKI and outcomes, both short- and long-term are ongoing, with an anticipated sample size of >8,000 by Kidney Week.

Conclusion

AKI occurs in nearly one-quarter of critically ill neonates using contemporary neonatal-specific KDIGO criteria and is independently associated with mortality and prolonged hospitalization. These findings support the need for standardized AKI surveillance in neonatal intensive care.

Table 1. Clinical Outcomes by AKI Status

Funding

• NIDDK Support