Neonatal AKI profile using KDIGO guidelines: A cohort study in tertiary care hospital ICU of Lahore, Pakistan

Abstract

Background AKI is witnessed in sick neonates and is associated with poor outcomes. Our cohort represents the profile of neonates who were diagnosed with AKI using KDIGO guidelines during intensive care unit stay. Methodology A cohort study was conducted in the NICU of FMH from June 2019 to May 2021. Data were collected on standardized proforma. Serum creatinine was measured within 24 hours after enrollment in the study by cytometric analysis using the C311 Rosch machine and subsequently after 24 to 48 hours. Data analysis was done using SPSS v 20.0. All continuous variables were not normally distributed and were expressed as the median and interquartile range (IQR). Categorical variables were analyzed by proportional differences with either the Pearson chi-square test or Fisher’s exact tests. A multinomial logistic regression model was used to explore the independent risk factors of AKI. Time to the event (death) and survival curves for the cohort were plotted by using Cox proportional hazard model. Results AKI occurred in 473 (37.6%) of neonates and 15.7%, 16.3% and 5.6% had stage 1, 2 and 3 respectively. The outborn birth (p 0.000, AOR 3.987, 95%CI 2.564 – 6.200), birth asphyxia (p 0.000, AOR 3.567, 95%CI 2.093 – 6.080), inotropic agent (p 0.000, AOR 2.060, 95%CI 1.436 – 2.957), antenatal steroids (p 0.002, AOR 1.721, 95%CI 1.213 – 2.443), central lines (p 0.005, AOR 1.630, 95%CI 1.155 – 2.298), IVH/ICH/DIC (p 0.009, AOR1.580 , 95%CI 1.119 – 2.231) and NEC (p 0.054, AOR 1.747, 95%CI 0.990 – 3.083) were independently associated with AKI. Protective factors of neonatal AKI were normal sodium levels, maternal diabetes mellitus as well Hb>10.5 mg/dl. Duration of stay (7 vs 9 days) and mortality rates (3.9% vs16.5%) were significantly higher in neonates with AKI (p <0.001). Conclusion About one-third of critically sick neonates had AKI. Significant risk factors for AKI were outborn birth (298%), birth asphyxia (256%), inotropic agents (106%) %, NEC 74.7%, antenatal steroids 72%, central lines 63% and IVH/ICH/DIC 58%. AKI prolongs the duration of stay and reduces the survival of sick neonates.