Acute Kidney Injury is Associated with Poor Lung Outcomes in Infants Born ≥32 Weeks of Gestational Age
Michelle C Starr, Louis Boohaker, Laurie C Eldredge, Shina Menon, Russell Griffin, Dennis Mayock, David Askenazi, Sangeeta Hingorani, Neonatal Kidney Collaborative, Namasivayam Ambalavanan, David T Selewski, Subrata Sarkar, Alison Kent, Jeffery Fletcher, Carolyn L Abitbol, Marissa DeFreitas, Shahnaz Duara, Jennifer R Charlton, Jonathan R Swanson, Ronnie Guillet, Carl D'Angio, Ayesa Mian, Erin Rademacher, Maroun J Mhanna, Rupesh Raina, Deepak Kumar, Jennifer G Jetton, Patrick D Brophy, Tarah T Colaizy, Jonathan M Klein, Ayse Akcan Arikan, Christopher J Rhee, Stuart L Goldstein, Amy T Nathan, Juan C Kupferman, Alok Bhutada, Shantanu Rastogi, Elizabeth Bonachea, John Mahan, F Sessions Cole, T Keefe Davis, Joshua Dower, Lawrence Milner, Alexandra Smith, Mamta Fuloria, Kimberly Reidy, Frederick J Kaskel, Danielle E Soranno, Jason Gien, Katja M Gist, Aftab S Chishti, Mina H Hanna, Craig S Wong, Catherine Joseph, Tara DuPont, Robin Ohls, Amy Staples, Surender Khokhar, Sofia Perazzo, Patricio E Ray, Mary Revenis, Sidharth K Sethi, Smriri Rohatgi, Cherry Mammen, Anne Synnes, Sanjay Wazir, Pia Wintermark, Robert Woroniecki, Shanty Sridhar, Susan Ingraham, Arwa Nada, Michael Zappitelli, Michelle C Starr, Louis Boohaker, Laurie C Eldredge, Shina Menon, Russell Griffin, Dennis Mayock, David Askenazi, Sangeeta Hingorani, Neonatal Kidney Collaborative, Namasivayam Ambalavanan, David T Selewski, Subrata Sarkar, Alison Kent, Jeffery Fletcher, Carolyn L Abitbol, Marissa DeFreitas, Shahnaz Duara, Jennifer R Charlton, Jonathan R Swanson, Ronnie Guillet, Carl D'Angio, Ayesa Mian, Erin Rademacher, Maroun J Mhanna, Rupesh Raina, Deepak Kumar, Jennifer G Jetton, Patrick D Brophy, Tarah T Colaizy, Jonathan M Klein, Ayse Akcan Arikan, Christopher J Rhee, Stuart L Goldstein, Amy T Nathan, Juan C Kupferman, Alok Bhutada, Shantanu Rastogi, Elizabeth Bonachea, John Mahan, F Sessions Cole, T Keefe Davis, Joshua Dower, Lawrence Milner, Alexandra Smith, Mamta Fuloria, Kimberly Reidy, Frederick J Kaskel, Danielle E Soranno, Jason Gien, Katja M Gist, Aftab S Chishti, Mina H Hanna, Craig S Wong, Catherine Joseph, Tara DuPont, Robin Ohls, Amy Staples, Surender Khokhar, Sofia Perazzo, Patricio E Ray, Mary Revenis, Sidharth K Sethi, Smriri Rohatgi, Cherry Mammen, Anne Synnes, Sanjay Wazir, Pia Wintermark, Robert Woroniecki, Shanty Sridhar, Susan Ingraham, Arwa Nada, Michael Zappitelli
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.
Conflict of interest statement
All authors report no real or perceived conflicts of interest that could affect the study design; collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication. This study was supported by the NIH U01NS077953 (L.B., R.G., D.A.) and T32DK007662 (M.C.S.). For full disclosure, we provide the additional list of authors' other commitments and funding sources that are not directly related to this study. D.A. reported serving on the speaker board for Baxter and for the Acute Kidney Injury Foundation; he also reported receiving grant funding for studies not related to this work: grant R01 DK103608 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases and grant R01 FD005092 from the National Institutes of Health/U.S. Food and Drug Administration. No other disclosures were reported.
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Source: PubMed