Incidence, Risk Factors, and Outcomes of Neonatal Acute Kidney Injury: Protocol of a Multicentric Prospective Cohort Study [The Indian Iconic Neonatal Kidney Educational Registry]

Abstract

Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is sparse. Neonatal AKI is an independent risk factor for increased mortality and prolonged hospital stay. There are stark differences in the epidemiology of AKI in neonates amongst the developing and the developed world. Increased prevalence of neonatal sepsis, lack of awareness about neonatal AKI and poor access to pediatric nephrologists add to the improper management of neonatal AKI in the developing countries.Methods: This study is a multicentric, national, prospective cohort study [The Indian iconic Neonatal Kidney Educational Registry (TINKER)] conducted in level 2–3 NICUs in 11 centers across India. We have enrolled nearly 2,000 neonates over the study period. Neonates (≤ 28 days) who were admitted in NICU and those who received intravenous (IV) fluids for at least 48 h for hydration and/or nutrition have been included. Data collection included: (1) baseline demographics (2) daily physiologic and laboratory parameters (3) discharge data. KDIGO workgroup AKI definition modified for neonates was used for defining AKI. Data entry was carried out by individual participating centers using a web-based database (akiregistry.org). De-identified data has been maintained and handled by the principal investigator (PI). This collaboration plans to disseminate data through peer-reviewed publications and through presentations at educational conferences.Conclusions: The purpose of this study is to create the first prospective neonatal all-cause AKI data repository and describe the incidence of neonatal AKI in NICUs in the country and determine the risk factors as well as the outcomes of such neonates—both short-term and long-term outcomes. This will eventually spur therapeutic advancements, facilitate decipherment of epidemiological trends, risk factors as well as outcomes and identify disparities in management across the nation.

Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study

“…A complete protocol of data collection and entry is mentioned in TINKER study publication. 13 Data were collected in the TINKER study by researchers assessing all the neonates admitted to the level 2-3 NICUs in 11 centres across India using a paper-based questionnaire/electronic medical records database. Data entry was conducted by each of the participating centres using a webbased database (akiregistry.org).…”

“…The median (IQR) duration of stay in NICU was 10 (6-20.3) days and 65 (13.2%) died during NICU stay. AKI neonates with PD as compared to AKI neonates without PD had a significantly lower median (IQR) duration of stay in NICU (7 (4-14) vs. 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days; p ¼ 0.004), but significantly higher mortality (31 (70.5%) vs. 34 (7.6%); p < 0.001). This discrepancy was likely attributable to initial poor clinical conditions (sepsis with multiple organ dysfunction syndrome (MODS)) rather than acute PDrelated complications.…”

“…A large multicentre, national, prospective cohort study (TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry)) has enrolled 1600 neonates from level 2 and 3 NICUs in 11 centres across India. 13 This is the largest prospective, multicentre study, recruiting admitted neonates specifically looking at AKI and outcomes. The current study analysed the risk factors and outcomes for neonates with AKI who needed acute PD from the TINKER cohort.…”

STARZ Neonatal AKI Risk Stratification Cut-off Scores for Severe AKI and Need for Dialysis in Neonates

“…Neonatal acute kidney injury (AKI) is a significant pathology associated with higher mortality rates, longer neonatal intensive care stay and worse clinical outcomes (1,2). In order to mitigate the avoidable outcomes, it is important to identify AKI early and start early therapeutic measures (2,3).…”

“…Neonatal acute kidney injury (AKI) is a significant pathology associated with higher mortality rates, longer neonatal intensive care stay and worse clinical outcomes (1,2). In order to mitigate the avoidable outcomes, it is important to identify AKI early and start early therapeutic measures (2,3). There have been previous attempts at deriving illness severity scores in neonates and children such as the Clinical Risk Index for Babies (CRIB), and the Simplified age-weight-sex score (SAWS), Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) (4).…”