Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation

Jennifer Chmielewski; Paulomi M Chaudhry; Matthew W Harer; Shina Menon; Andrew M South; Ashley Chappell; Russell Griffin; David Askenazi; Jennifer Jetton; Michelle C Starr; Neonatal Kidney Collaborative

doi:10.1038/s41372-022-01424-3

Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation

J Perinatol. 2022 Jul;42(7):930-936. doi: 10.1038/s41372-022-01424-3. Epub 2022 Jun 8.

Authors

Collaborators

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, Susan Ingraham, John Mahan, Arwa Nada, 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, Sangeeta Hingorani, Sandra Juul, Craig S Wong, Catherine Joseph, Tara DuPont, Robin Ohls, Amy Staples, Smriti Rohatgi, Sidharth K Sethi, Sanjay Wazir, Surender Khokhar, Sofia Perazzo, Patricio E Ray, Mary Revenis, Cherry Mammen, Anne Synnes, Pia Wintermark, Michael Zappitelli, Robert Woroniecki, Shanthy Sridhar

Affiliations

¹ Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA.
² Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA.
³ Department of Pediatrics, Division of Neonatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁴ Division of Nephrology, University of Washington and Seattle Children's Hospital, Seattle, WA, USA.
⁵ Department of Pediatrics, Section of Nephrology, Brenner Children's, Wake Forest School of Medicine, Winston Salem, NC, USA.
⁶ Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA.
⁷ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹ Division of Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
¹⁰ Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA. mcstarr@iu.edu.
¹¹ Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA. mcstarr@iu.edu.

Abstract

Objective: To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association.

Study design: Secondary analysis of AWAKEN multicenter retrospective cohort.

Exposures: AKI severity and diagnostic criteria.

Outcome: AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation.

Results: Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5-109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3-95.3%) of the total effect of AKI diagnostic criteria on documentation.

Conclusion: We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Acute Kidney Injury* / diagnosis
Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / therapy
Documentation
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Nephrology*
Patient Discharge
Referral and Consultation
Retrospective Studies

Abstract

Publication types

MeSH terms

Grants and funding