ESPN 51th Annual Meeting

ESPN 2018


 
The Association between Neonatal Renal Diseases and Mortality: A Retrospective Cross-sectional Study.
EYAL RACHMANY 1 MIRIAM DAVIDOVITZ 1 GIL KLINGER 2 DANIEL LANDAU 3

1- DEPARTMENT OF NEPHROLOGY, SCHNEIDER CHILDRENS MEDICAL CENTER OF ISRAEL
2- DEPARTMENT OF NEONATOLOGY, SCHNEIDER CHILDRENS MEDICAL CENTER OF ISRAEL
3- PEDIATRICS DEPT B, SCHNEIDER CHILDRENS MEDICAL CENTER. SACKLER SCHOOL OF MEDICINE, TEL AVIV UNIVERSITY, ISRAEL
 
Introduction:

The extent and impact of neonatal acute kidney injury (AKI) has been reported mainly in the very low birth weight infant population. In addition, different trajectories of elevated serum creatinine (SCr) in the neonatal period may not qualify for the recommended definitions of AKI, given the maturation of kidney function after birth.  Our objectives were: 1) To characterize the prevalence of 3 different mutially exclusive types of renal morbidities amongst Neonatal Intensive Care Unit (NICU) patients: AKI, bilateral CAKUT and transient elevation of SCr (TESCr).  2) To identify independent risk factors for mortality amongst NICU neonates with renal disease, including AKI. 

Material and methods:

Retrospective cross-sectional study of all neonates born or treated during 2005 at the Schneider Childrens Medical Center of Israel and had at least 2 serum creatinine (SCr) tests after the age of 48 hours in their first 30 days of life. AKI was defined using KDIGO criteria. Bilateral CAKUT was diagnosed for persistant elevation of SCr and bilateral structural anomalies. TESCr was diagnosed in those neonates who had at least one Jaffe-based SCr value of 1.1 mg/dL or higher after age 1 day which normalized within 3 months.  Demographic and gestational features, as well as renal parameters, comorbidities, mortality and survival  (up to December 31, 2016) were compared. Univariate and multivariate analyses compared the 3 renal morbidity groups with a NICU control group who also had at least 2 normal SCr values.  

Results:

The 673 study neonates had an average gestational age of 35.1±4.1 weeks, birth weight of 2378±888 g and male prevalence of 57.1%. The research groups included: 183 infants (27.2%) with AKI, 12 infants (1.8%) with bilateral CAKUT, 65 infants (9.7%) with TESCr and 414 (61.5%) control infants. The AKI group differed from the rest, including: lower birth weight and gestational age (2010±980 vs. 2499±2540 grams, p<0.001 and 32.7±4.8 vs. 35.3-36.5 weeks respectively, p<0.001) and more congenital cyanotic heart disease (14.8% vs. 1.5-2.4% in the control and TESCr groups, p<0.001). During follow-up, 41 neonates died (6.1% of the entire study population), of which 30 (73.2%) died during the neonatal hospitalization. Mortality rate was 13.8% in AKI vs. 3.1%  in controls (p < 0.001 by univariate analysis). Multivariate analysis did not identify AKI as a significant independent risk factor for mortality. However, a SCr value > 1.1 mg/dL was independently associated with mortality (OR=4.69, 95% CI=2.33-9.43; p<0.001), as well as congenital heart diseases (OR=3.77, 95% CI=1.84-7.73; p<0.001). The Receiver operating characteristic (ROC) area under the curve for these 2 parameters was 0.795

Conclusions:

Neonates characterized by their renal morbidity subtypes differ significantly from controls. This neonatal cohort shows a higher BW and GA than previous AKI reports. The longer term renal effects of AKI and TESCr  (as markers of decreased renal reserve) remain to be determined. A Jaffe-based serum creatinine higher than 1.1 mg/dL, but not AKI, was found as an independent risk factor for mortality among NICU neonates.