University of North Carolina Department of Medicine-Nephrology, Chapel Hill, NC, USA.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Pediatr Res. 2024 Aug;96(3):740-749. doi: 10.1038/s41390-024-03102-w. Epub 2024 Mar 4.
We evaluated time-varying perinatal risk factors associated with early (≤7 post-natal days) and late (>7 post-natal days) severe acute kidney injury (AKI) occurrence and duration.
A secondary analysis of Preterm Erythropoietin Neuroprotection Trial data. We defined severe AKI (stage 2 or 3) per neonatal modified Kidney Disease: Improving Global Outcomes criteria. Adjusted Cox proportional hazards models were conducted with exposures occurring at least 72 h before severe AKI. Adjusted negative binomial regression models were completed to evaluate risk factors for severe AKI duration.
Of 923 participants, 2% had early severe AKI. In the adjusted model, gestational diabetes (adjusted HR (aHR) 5.4, 95% CI 1.1-25.8), non-steroidal anti-inflammatory drugs (NSAIDs) (aHR 3.2, 95% CI 1.0-9.8), and vancomycin (aHR 13.9, 95% CI 2.3-45.1) were associated with early severe AKI. Late severe AKI occurred in 22% of participants. Early severe AKI (aHR 2.5, 95% CI 1.1-5.4), sepsis (aHR 2.5, 95% CI 1.4-4.4), vasopressors (aHR 2.9, 95% CI 1.8-4.6), and diuretics (aHR 2.6, 95% CI 1.9-3.6) were associated with late severe AKI. Participants who had necrotizing enterocolitis or received NSAIDs had longer severe AKI duration.
We identified major risk factors for severe AKI that can be the focus of future research.
Time-dependent risk factors for severe acute kidney injury (AKI) and its duration are not well defined among infants born <28 weeks' gestation. Over 1 in 5 infants born <28 weeks' gestation experienced severe AKI, and this study identified several major time-dependent perinatal risk factors occurring within 72 h prior to severe AKI. This study can support efforts to develop risk stratification and clinical decision support to help mitigate modifiable risk factors to reduce severe AKI occurrence and duration.
我们评估了与早发（≤7 天）和晚发（>7 天）严重急性肾损伤（AKI）发生和持续时间相关的围产期时变风险因素。
对早产儿促红细胞生成素神经保护试验数据进行二次分析。我们根据新生儿改良肾脏病：改善全球结局标准定义严重 AKI（第 2 或 3 期）。在严重 AKI 前至少 72 小时发生的暴露情况下，采用调整后的 Cox 比例风险模型进行分析。采用调整后的负二项回归模型评估严重 AKI 持续时间的风险因素。
在 923 名参与者中，有 2%发生早发性严重 AKI。在调整后的模型中，妊娠期糖尿病（调整后的 HR[aHR]5.4，95%CI1.1-25.8）、非甾体抗炎药（NSAIDs）（aHR3.2，95%CI1.0-9.8）和万古霉素（aHR13.9，95%CI2.3-45.1）与早发性严重 AKI 相关。22%的参与者发生晚发性严重 AKI。早发性严重 AKI（aHR2.5，95%CI1.1-5.4）、败血症（aHR2.5，95%CI1.4-4.4）、血管加压药（aHR2.9，95%CI1.8-4.6）和利尿剂（aHR2.6，95%CI1.9-3.6）与晚发性严重 AKI 相关。患有坏死性小肠结肠炎或使用 NSAIDs 的参与者严重 AKI 持续时间较长。
我们确定了严重 AKI 的主要危险因素，这可以成为未来研究的重点。
<28 周出生的婴儿中严重 AKI 及其持续时间的时间依赖性危险因素尚未得到很好的定义。超过 1/5 的<28 周出生的婴儿发生严重 AKI，本研究确定了严重 AKI 发生前 72 小时内发生的几个主要时间依赖性围产期风险因素。本研究可以支持努力制定风险分层和临床决策支持，以帮助减轻可改变的风险因素，从而降低严重 AKI 的发生和持续时间。
