Incidence, Predictors, and Outcomes Associated with Recurrent Neonatal Acute Kidney Injury in Preterm Infants: A Secondary Analysis of the Preterm Erythropoietin Neuroprotection Trial (PENUT).

BACKGROUND

Recurrent neonatal acute kidney injury (rAKI) may increase morbidity and mortality but remains understudied. We aimed to determine the incidence, risk factors, and clinical outcomes associated with rAKI in extremely low gestational age newborns (ELGANs), hypothesizing that rAKI would be associated with worse outcomes than no AKI or single AKI (sAKI).

METHODS

We performed a secondary analysis (ALMOND study) of the multicenter Preterm Erythropoietin Neuroprotection (PENUT) Trial conducted from 2013-2016. AKI was diagnosed retrospectively using modified neonatal Kidney Disease: Improving Global Outcomes serum creatinine criteria. Outcomes included length of stay (LOS), bronchopulmonary dysplasia (BPD), mortality, and chronic kidney disease (CKD) and hypertension (HTN) at 2 years. Comparisons among no AKI, sAKI, and rAKI groups used multivariable generalized estimating equation regression and Cox proportional hazards models.

RESULTS

Among 923 ELGANs, 211 (23%) developed rAKI. Risk factors included younger gestational age, lower birthweight, small for gestational age, lower Apgar scores, patent ductus arteriosus, severe sepsis, nephrotoxic medication exposure, hypotension, BPD, and necrotizing enterocolitis (all p < 0.05).