Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately

Murphy, Heidi J; Gien, Jason; Sahay, Rashmi; King, Eileen; Selewski, David T.; Bridges, Brian C.; Cooper, David S.; Fleming, Geoffrey M.; Paden, Matthew L.; Zappitelli, Michael; Gist, Katja M.; Basu, Rajit K.; Askenazi, David

doi:10.1159/000512538

Cited by 18 publications

(14 citation statements)

References 35 publications

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“…The use of ECMO was not associated with neonatal AKI in our population, but only five of our infants underwent ECMO. The increase in incidence of AKI has been previously reported in CDH infants requiring ECMO [ 5 , 8 , 9 , 16 ]. In those two studies inhouse ECMO was available [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 82%

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Acute kidney injury in infants with congenital diaphragmatic hernia

et al. 2022

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Objectives To assess the incidence of acute kidney injury (AKI) in infants with congenital diaphragmatic hernia (CDH), including those who had fetoscopic endoluminal tracheal occlusion (FETO), and the effect of AKI on mortality and length of stay. Study design Ten-year retrospective review of infants admitted with CDH to a tertiary perinatal centre. Result Ninety-four infants with median gestational age of 38+1 weeks were included. Fifty-nine (62.8%) infants had AKI. Compared to infants without AKI, infants with AKI, had a similar incidence of mortality (p = 0.989). In survivors, AKI was not independently associated with a longer adjusted median length of stay [23 versus 15 days (p = 0.194)]. FETO was associated with an increased risk of AKI (p = 0.005), but neither the mortality nor length of stay of FETO infants who had AKI was increased. Conclusion AKI was present in the majority of infants with CDH and most common in those who had undergone FETO.

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Section: Discussionmentioning

confidence: 82%

“…In those two studies inhouse ECMO was available [ 5 , 6 ]. In other studies, CDH infants were included as a subgroup in identifying the incidence of AKI in infants who underwent ECMO for various indications [ 8 , 9 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in infants with congenital diaphragmatic hernia

et al. 2022

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“…Previous reports from the KIDMO group have emphasized the negative impact of FO and AKI on outcomes in various cohorts. [5][6][7][8][9][10] Our data suggest that ongoing fluid accumulation while on ECMO following eCPR is detrimental and worsens outcomes. This report substantiates the idea that FO may represent a modifiable factor that impacts outcomes.…”

Section: Discussionmentioning

confidence: 93%

Acute Kidney Injury and Fluid Overload in Pediatric Extracorporeal Cardio-Pulmonary Resuscitation: A Multicenter Retrospective Cohort Study

et al. 2022

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Acute kidney injury (AKI) and fluid overload (FO) are common complications of extracorporeal membrane oxygenation (ECMO). The purpose of this study was to characterize AKI and FO in children receiving extracorporeal cardiopulmonary resuscitation (eCPR). We performed a multicenter retrospective study of children who received eCPR. AKI was assessed during ECMO and FO defined as <10% [FO−] vs. ≥10% [FO+] evaluated at ECMO initiation and discontinuation. A composite exposure, defined by a four-group discrete phenotypic classification [FO−/AKI−, FO−/AKI+, FO+/AKI−, FO+/AKI+] was also evaluated. Primary outcome was mortality and hospital length of stay (LOS) among survivors. 131 patients (median age 29 days (IQR:9, 242 days); 51% men and 82% with underlying cardiac disease) were included. 45.8% survived hospital discharge. FO+ at ECMO discontinuation, but not AKI was associated with mortality [aOR=2.3; 95% CI: 1.07–4.91]. LOS for FO+ patients was twice as long as FO− patients, irrespective of AKI status [(FO+/AKI+ (60 days; IQR: 49-83) vs. FO−/AKI+ (30 days, IQR: 19–48 days); P = 0.01]. FO+ at ECMO initiation and discontinuation was associated with an adjusted 66% and 50% longer length of stay respectively. Prospective studies that target timing and strategy of fluid management, including its removal in children receiving ECPR are greatly needed.

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“…In a retrospective single-center study of 242 neonates treated with ECLS, Zwiers et al found the incidence of AKI was 64% with the most severe stage of AKI associated with increased mortality ( 45 ). In a recent report from the multicenter Kidney Interventions During Membrane Oxygenation (KIDMO) study group about 446 neonates treated with ECLS, the incidence of AKI in the overall cohort was 51%, but the AKI incidence varied by underlying diagnosis (cardiac 68%, congenital diaphragmatic hernia 38%, respiratory 33%) ( 49 ). The association of AKI with outcomes varied significantly by underlying diagnosis as well.…”

Section: Epidemiology Risk Factors and Outcomes Of Neonatal Akimentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2022

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Acute kidney injury (AKI) is a common occurrence in the neonatal intensive care unit (NICU). In recent years, our knowledge of the incidence and impact of neonatal AKI on outcomes has expanded exponentially. Neonatal AKI has been shown to be associated with adverse outcomes including increased length of mechanical ventilation, prolonged length of stay, and rise in mortality. There has also been increasing work suggesting that neonates with AKI are at higher risk of chronic kidney disease (CKD). In the past, AKI had been defined multiple ways. The utilization of the neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria as the standard definition for neonatal AKI in research and clinical care has driven the advances in our understanding of neonatal AKI over the last 10 years. This definition has allowed researchers and clinicians to better understand the incidence, risk factors, and outcomes associated with neonatal AKI across populations through a multitude of single-center studies and the seminal, multicenter Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study. As the impacts of neonatal AKI have become clear, a shift in efforts toward identifying those at highest risk, protocolizing AKI surveillance, improving prevention and diagnosis, and expanding kidney support therapy (KST) for neonates has occurred. These efforts also include improving risk stratification (identifying high risk populations, including those with nephrotoxic medication exposure) and diagnostics (novel biomarkers and diagnostic tools). Recent work has also shown that the targeted use of methylxanthines may prevent AKI in a variety of high-risk populations. One of the most exciting developments in neonatal AKI is the advancement in technology to provide KST to neonates with severe AKI. In this comprehensive review we will provide an overview of recent work and advances in the field of neonatal AKI. This will include a detailed review of (1) the definition of neonatal AKI, (2) the epidemiology, risk factors, and outcomes associated with neonatal AKI, (3) improvements in risk stratification and diagnostics, (4) mitigation and treatment, (5) advancements in the provision of KST to neonates, and (6) the incidence and risk of subsequent CKD.

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Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately

Cited by 18 publications

References 35 publications

Acute kidney injury in infants with congenital diaphragmatic hernia

Acute kidney injury in infants with congenital diaphragmatic hernia

Acute Kidney Injury and Fluid Overload in Pediatric Extracorporeal Cardio-Pulmonary Resuscitation: A Multicenter Retrospective Cohort Study

Neonatal Acute Kidney Injury

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