Study of neonatal acute kidney injury based on KDIGO criteria

Abstract

Background: Significant advancement has occurred over the years in diagnosis, recognition, intervention and impact of acute kidney injury (AKI) on morbidity and mortality in critically-ill neonates. However an increased risk of chronic kidney disease (CKD) is still observed among neonates who survive an episode of AKI. Therefore, preventing and adequately managing AKI in neonates could help in controlling long-term renal morbidity in neonates who develop AKI. Thus, this study was undertaken with the aim of studying the incidence, contributing factors and outcomes of AKI in at-risk term neonates admitted to the neonatal intensive care unit (NICU).

Methods: One hundred and ninety-six term neonates admitted to the NICU with sepsis, hypoxic ischemic encephalopathy (HIE), dehydration and respiratory distress were enrolled and evaluated over a period of one year. Detailed maternal history along with neonatal history, anthropometry, vitals and clinical signs of neonates were recorded in a pretested proforma. Urine output was measured in all at-risk neonates. Serum creatinine was estimated to categorize AKI into stages as per modified KDIGO criteria.

Results: Incidence of AKI was 21%, (n = 107 out of 510 admissions) in the study. Mortality was significantly higher in AKI stage III neonates (88.9%) (p < 0.001). Multivariate analysis revealed that hypoxic ischemic encephalopathy (HIE) had 35.293 (p < 0.001) times higher risk, while sepsis had 35.701 (p < 0.001), dehydration had 30.260 times (p < 0.001) and respiratory distress had 10.366 times (p < 0.001) higher risk of developing AKI.

Conclusion: Our study recorded a high incidence of AKI among at-risk neonates. KDIGO criteria for diagnosing AKI is feasible to apply in the at-risk neonates and helps in its early identification. Early diagnosis and timely intervention in neonates with HIE, sepsis, dehydration and respiratory can prevent the progression of AKI and thus improve prognoses.

Keywords: AKI; HIE; mortality; neonates; sepsis.