Pediatric nephrology (Berlin, Germany) · 2025
High early fluid and sodium intake as risk factors for acute kidney injury in very-low-birthweight infants.
СтатьяНазвание и аннотация: Перевод в очереди
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Mäkelä Pauliina M, Immeli Lotta, Leskinen Markus, Sund Reijo, Jahnukainen Timo, Andersson Sture, Luukkainen Päivi
Аннотация
BACKGROUND: Acute kidney injury (AKI) is common in very-low-birthweight (VLBW) infants. Both fluid overload and dehydration can lead to AKI. Our aim was to examine the associations between early fluid and sodium intake and AKI.
METHODS: This retrospective cohort study comprised 421 VLBW infants born at < 32 weeks. Detailed data on fluid management during the first 24 h of life, diuresis and weight changes during the first postnatal week and plasma creatinine measurements during the first 2 postnatal weeks were acquired from an electronic patient information system. AKI was defined according to the KDIGO definition modified for neonates.
RESULTS: The incidence of AKI was 8.6%, and on average, it was diagnosed on the fifth postnatal day. Higher total fluid intake (mL/kg/24 h) during the first day of life was associated with an increased risk of AKI (OR, 1.015; 95% CI, 1.005-1.025; p < 0.01), analysis adjusted for gestational age and being small-for-gestational age. The highest fluid intake quartile had a 5.6-fold risk of developing AKI when compared with the lowest quartile (p = 0.01). A higher total sodium intake (mmol/kg/24 h) was associated with an increased risk of AKI (OR, 1.12; 95% CI, 1.03-1.21; p < 0.01). Among infants with AKI, a substantial proportion of early fluid and sodium intake (median 27% and 59% of total intake, respectively) originated from volume expanders. Infants diagnosed with AKI exhibited an average weight gain of + 2.8% by the second day of life.
CONCLUSIONS: As part of efforts to minimize the risk of AKI, avoiding excessive fluid and sodium administration during the first postnatal hours may be beneficial.
METHODS: This retrospective cohort study comprised 421 VLBW infants born at < 32 weeks. Detailed data on fluid management during the first 24 h of life, diuresis and weight changes during the first postnatal week and plasma creatinine measurements during the first 2 postnatal weeks were acquired from an electronic patient information system. AKI was defined according to the KDIGO definition modified for neonates.
RESULTS: The incidence of AKI was 8.6%, and on average, it was diagnosed on the fifth postnatal day. Higher total fluid intake (mL/kg/24 h) during the first day of life was associated with an increased risk of AKI (OR, 1.015; 95% CI, 1.005-1.025; p < 0.01), analysis adjusted for gestational age and being small-for-gestational age. The highest fluid intake quartile had a 5.6-fold risk of developing AKI when compared with the lowest quartile (p = 0.01). A higher total sodium intake (mmol/kg/24 h) was associated with an increased risk of AKI (OR, 1.12; 95% CI, 1.03-1.21; p < 0.01). Among infants with AKI, a substantial proportion of early fluid and sodium intake (median 27% and 59% of total intake, respectively) originated from volume expanders. Infants diagnosed with AKI exhibited an average weight gain of + 2.8% by the second day of life.
CONCLUSIONS: As part of efforts to minimize the risk of AKI, avoiding excessive fluid and sodium administration during the first postnatal hours may be beneficial.