Acute Kidney Injury is Associated with Poor Lung Outcomes in Infants Born ≥32 Weeks of Gestational Age

Abstract

Objective This study aimed to evaluate the association between acute kidney injury (AKI) and lung outcomes in infants born ≥32 weeks of gestational age (GA).

Study Design Secondary analysis of infants ≥32 weeks of GA in the assessment of worldwide acute kidney injury epidemiology in neonates (AWAKEN) retrospective cohort (n = 1,348). We used logistic regression to assess association between AKI and a composite outcome of chronic lung disease (CLD) or death at 28 days of age and linear regression to evaluate association between AKI and duration of respiratory support.

Results CLD occurred in 82/1,348 (6.1%) infants, while death occurred in 22/1,348 (1.6%); the composite of CLD/death occurred in 104/1,348 (7.7%). Infants with AKI had an almost five-fold increased odds of CLD/death, which remained after controlling for GA, maternal polyhydramnios, multiple gestations, 5-minute Apgar's score, intubation, and hypoxic–ischemic encephalopathy (adjusted odds ratio [OR] = 4.9, 95% confidence interval [CI]: 3.2–7.4; p < 0.0001). Infants with AKI required longer duration of respiratory support (count ratio = 1.59, 95% CI: 1.14–2.23, p = 0.003) and oxygen (count ratio = 1.43, 95% CI: 1.22–1.68, p < 0.0001) compared with those without AKI.

Conclusion AKI is associated with CLD/death and longer duration of respiratory support in infants born at ≥32 weeks of GA. Further prospective studies are needed to elucidate the pathophysiologic relationship.

Keywords

acute kidney injury - acute renal failure - acute lung injury - chronic lung disease - organ crosstalk - neonate

• References

• 1 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
• 2 Raju TN. Late-preterm births: challenges and opportunities. Pediatrics 2008; 121 (02) 402-403
• 3 Martin JA, Kirmeyer S, Osterman M, Shepherd RA. Born a bit too early: recent trends in late preterm births. NCHS Data Brief 2009; (24) 1-8
• 4 Engle WA, Tomashek KM, Wallman C. ; Committee on Fetus and Newborn, American Academy of Pediatrics. “Late-preterm” infants: a population at risk. Pediatrics 2007; 120 (06) 1390-1401
• 5 Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin Perinatol 2006; 30 (01) 28-33
• 6 Johnson TJ, Patel AL, Jegier BJ, Engstrom JL, Meier PP. Cost of morbidities in very low birth weight infants. J Pediatr 2013; 162 (02) 243-49.e1
• 7 Russell RB, Green NS, Steiner CA. , et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics 2007; 120 (01) e1-e9
• 8 Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. ; AWARE Investigators. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 2017; 376 (01) 11-20
• 9 Jetton JG, Boohaker LJ, Sethi SK. , et al; Neonatal Kidney Collaborative (NKC). Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 2017; 1 (03) 184-194
• 10 Basu RK, Wheeler DS. Kidney-lung cross-talk and acute kidney injury. Pediatr Nephrol 2013; 28 (12) 2239-2248
• 11 Dodd-O JM, Hristopoulos M, Scharfstein D. , et al. Interactive effects of mechanical ventilation and kidney health on lung function in an in vivo mouse model. Am J Physiol Lung Cell Mol Physiol 2009; 296 (01) L3-L11
• 12 Levy EM, Viscoli CM, Horwitz RI. The affect of acute renal failure on mortality. A cohort analysis. JAMA 1996; 275 (19) 1489-1494
• 13 Li X, Hassoun HT, Santora R, Rabb H. Organ crosstalk: the role of the kidney. Curr Opin Crit Care 2009; 15 (06) 481-487
• 14 Askenazi D, Patil NR, Ambalavanan N. , et al. Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants. Pediatr Nephrol 2015; 30 (09) 1511-1518
• 15 Jetton JG, Guillet R, Askenazi DJ. , et al; Neonatal Kidney Collaborative. Assessment of worldwide acute kidney injury epidemiology in neonates: design of a retrospective cohort study. Front Pediatr 2016; 4 (10) 68
• 16 Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012; 24 (02) 191-196
• 17 Zappitelli M, Ambalavanan N, Askenazi DJ. , et al. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res 2017; 82 (04) 569-573
• 18 Selewski DT, Charlton JR, Jetton JG. , et al. Neonatal acute kidney injury. Pediatrics 2015; 136 (02) e463-e473
• 19 Kellum JA, Lameire N. ; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013; 17 (01) 204
• 20 Sutherland SM, Byrnes JJ, Kothari M. , et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 2015; 10 (04) 554-561
• 21 Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 2010; 38 (03) 933-939
• 22 Balena-Borneman J, Ambalavanan N, Tiwari HK, Griffin RL, Halloran B, Askenazi D. Biomarkers associated with bronchopulmonary dysplasia/mortality in premature infants. Pediatr Res 2017; 81 (03) 519-525
• 23 Noh M, Lee Y. Extended negative binomial hurdle models. Stat Methods Med Res 2018; 1: 962280218766567
• 24 Oh W, Poindexter BB, Perritt R. , et al; Neonatal Research Network. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr 2005; 147 (06) 786-790
• 25 Rocha G, Ribeiro O, Guimarães H. Fluid and electrolyte balance during the first week of life and risk of bronchopulmonary dysplasia in the preterm neonate. Clinics (São Paulo) 2010; 65 (07) 663-674
• 26 Grigoryev DN, Liu M, Hassoun HT, Cheadle C, Barnes KC, Rabb H. The local and systemic inflammatory transcriptome after acute kidney injury. J Am Soc Nephrol 2008; 19 (03) 547-558
• 27 Madershahian N, Liakopoulos OJ, Wippermann J. , et al. The impact of intraaortic balloon counterpulsation on bypass graft flow in patients with peripheral ECMO. J Card Surg 2009; 24 (03) 265-268
• 28 Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med 2012; 13 (03) 253-258
• 29 Piazze JJ, Maranghi L, Cosmi EV, Anceschi MM. The effect of polyhydramnios and oligohydramnios on fetal lung maturity indexes. Am J Perinatol 1998; 15 (04) 249-252
• 30 Jensen EA, Wright CJ. Bronchopulmonary Dysplasia: The Ongoing Search for One Definition to Rule Them All. J Pediatr 2018; 197: 8-10
• 31 Allen J, Zwerdling R, Ehrenkranz R. , et al; American Thoracic Society. Statement on the care of the child with chronic lung disease of infancy and childhood. Am J Respir Crit Care Med 2003; 168 (03) 356-396