Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' Gestation

Abstract

Objective This study aimed to evaluate the association between acute kidney injury (AKI) and bronchopulmonary dysplasia (BPD) in infants born <32 weeks of gestational age (GA).

Study Design Present study is a secondary analysis of premature infants born at <32 weeks of GA in the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) retrospective cohort (n = 546). We stratified by gestational age and used logistic regression to determine association between AKI and moderate or severe BPD/mortality.

Results Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47–2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07–8.61; p < 0.001).

Conclusion Neonates born between 29 and 32 weeks who develop AKI had a higher likelihood of moderate or severe BPD/death than those without AKI. Further studies are needed to validate our findings and evaluate mechanisms of multiorgan injury.

Keywords

acute renal failure - acute lung injury - bronchopulmonary dysplasia - chronic lung disease - organ crosstalk - prematurity - neonate

• References

• 1 Fanaroff AA, Stoll BJ, Wright LL. , et al; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196 (02) 147.e1-147.e8
• 2 Horbar JD, Carpenter JH, Badger GJ. , et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012; 129 (06) 1019-1026
• 3 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
• 4 Shima Y, Kumasaka S, Migita M. Perinatal risk factors for adverse long-term pulmonary outcome in premature infants: comparison of different definitions of bronchopulmonary dysplasia/chronic lung disease. Pediatr Int 2013; 55 (05) 578-581
• 5 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
• 6 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
• 7 Li X, Hassoun HT, Santora R, Rabb H. Organ crosstalk: the role of the kidney. Curr Opin Crit Care 2009; 15 (06) 481-487
• 8 Basu RK, Wheeler DS. Kidney-lung cross-talk and acute kidney injury. Pediatr Nephrol 2013; 28 (12) 2239-2248
• 9 Sutherland SM, Ji J, Sheikhi FH. , et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol 2013; 8 (10) 1661-1669
• 10 Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality. A cohort analysis. JAMA 1996; 275 (19) 1489-149
• 11 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
• 12 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
• 13 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
• 14 Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012; 24 (02) 191-196
• 15 Selewski DT, Charlton JR, Jetton JG. , et al. Neonatal acute kidney injury. Pediatrics 2015; 136 (02) e463-e473
• 16 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
• 17 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
• 18 Ehrenkranz RA, Walsh MC, Vohr BR. , et al; National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116 (06) 1353-1360
• 19 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
• 20 Jensen EA, Wright CJ. Bronchopulmonary Dysplasia: The Ongoing Search for One Definition to Rule Them All. J Pediatr 2018; 197: 8-10
• 21 Baker CD, Abman SH. Impaired pulmonary vascular development in bronchopulmonary dysplasia. Neonatology 2015; 107 (04) 344-351
• 22 Jobe AH. Mechanisms of Lung Injury and Bronchopulmonary Dysplasia. Am J Perinatol 2016; 33 (11) 1076-1078
• 23 Thébaud B, Abman SH. Bronchopulmonary dysplasia: where have all the vessels gone? Roles of angiogenic growth factors in chronic lung disease. Am J Respir Crit Care Med 2007; 175 (10) 978-985
• 24 De Paepe ME, Mao Q, Powell J. , et al. Growth of pulmonary microvasculature in ventilated preterm infants. Am J Respir Crit Care Med 2006; 173 (02) 204-211
• 25 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
• 26 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
• 27 Endre ZH, Kellum JA, Di Somma S. , et al. Differential diagnosis of AKI in clinical practice by functional and damage biomarkers: workgroup statements from the tenth Acute Dialysis Quality Initiative Consensus Conference. ADQI Consensus on AKI Biomarkers and Cardiorenal Syndromes 2013; 18230-44
• 28 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
• 29 McNicholas BA, Rezoagli E, Pham T. , et al; ESICM Trials Group and the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) Investigators. Impact of early acute kidney injury on management and outcome in patients with acute respiratory distress syndrome: a secondary analysis of a multicenter observational study. Crit Care Med 2019; 47 (09) 1216-1225