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Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation

Journal of Perinatology volume 42, pages 930–936 (2022)Cite this article

Subjects

Abstract

Objective

To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association.

Study design

Secondary analysis of AWAKEN multicenter retrospective cohort. Exposures: AKI severity and diagnostic criteria. Outcome: AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation.

Results

Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5–109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3–95.3%) of the total effect of AKI diagnostic criteria on documentation.

Conclusion

We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.

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Fig. 1: Bar graph illustrating the number of AKI cases at each AWAKEN site, with AKI discharge documentation status shown in colors, with documentation in light grey and no documentation in dark grey.

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Data availability

De‐identified individual participant data will be made available through the Neonatal Kidney Collaborative through their website www.babykidney.org. The data will be de‐identified and a limited access data set is available through a request form on that page. Data dictionaries, in addition to study protocol, and case report forms will be made available. The data will be made available to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal.

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Acknowledgements

The authors would like to thank Samantha Wallace (Department of Pediatrics, Indiana University School of Medicine) for help with technical editing and proofreading of this manuscript.

Funding

Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings and for the Neonatal Kidney Collaborative (NKC) steering committee annual meeting at The University of Alabama at Birmingham (UAB), as well as support for 2 of the AWAKEN study investigators at UAB (D.A. and R.G.). PICAN is part of the Department of Pediatrics at UAB and is funded by Children’s of Alabama hospital, UAB Department of Pediatrics, UAB School of Medicine, and UAB Center for Clinical and Translational Sciences (National Institutes of Health grant UL1TR001417). Finally, the AWAKEN study at The University of New Mexico was supported by the Clinical and Translational Science Center at The University of New Mexico (National Institutes of Health grant UL1TR001449) and by The University of Iowa Institute for Clinical and Translational Science (grant U54TR001356). The AWAKEN study investigators at the Canberra Hospital at the Australian National University Medical School were supported by the Canberra Hospital Private Practice Fund, and investigators at University of Virginia Children’s Hospital were supported by a 100 Women Who Care Grant from the 100 Women Charitable Foundation. The funding sources for this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA

    Jennifer Chmielewski & Michelle C. Starr

  2. Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Paulomi M. Chaudhry

  3. Department of Pediatrics, Division of Neonatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Matthew W. Harer

  4. Division of Nephrology, University of Washington and Seattle Children’s Hospital, Seattle, WA, USA

    Shina Menon

  5. Department of Pediatrics, Section of Nephrology, Brenner Children’s, Wake Forest School of Medicine, Winston Salem, NC, USA

    Andrew M. South

  6. Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA

    Andrew M. South

  7. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Ashley Chappell & Russell Griffin

  8. Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA

    David Askenazi & Namasivayam Ambalavanan

  9. Division of Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Jennifer Jetton

  10. Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Michelle C. Starr

  11. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    David T. Selewski, Subrata Sarkar, Jennifer G. Jetton, Patrick D. Brophy, Tarah T. Colaizy & Jonathan M. Klein

  12. Centenary Hospital for Women and Children, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia

    Alison Kent & Jeffery Fletcher

  13. Holtz Children’s Hospital, University of Miami, Miami, FL, USA

    Carolyn L. Abitbol, Marissa DeFreitas & Shahnaz Duara

  14. University of Virginia Children’s Hospital, Charlottesville, VA, USA

    Jennifer R. Charlton & Jonathan R. Swanson

  15. Golisano Children’s Hospital, University of Rochester, Rochester, NY, USA

    Ronnie Guillet, Carl D’Angio, Ayesa Mian & Erin Rademacher

  16. MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Maroun J. Mhanna, Rupesh Raina & Deepak Kumar

  17. Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Ayse Akcan Arikan & Christopher J. Rhee

  18. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Stuart L. Goldstein & Amy T. Nathan

  19. Maimonides Medical Center, Brooklyn, NY, USA

    Juan C. Kupferman, Alok Bhutada & Shantanu Rastogi

  20. Nationwide Children’s Hospital, Columbus, OH, USA

    Elizabeth Bonachea, Susan Ingraham, John Mahan & Arwa Nada

  21. Washington University, St. Louis, MO, USA

    F. Sessions Cole & T. Keefe Davis

  22. Tufts University School of Medicine, Boston, MA, USA

    Joshua Dower, Lawrence Milner & Alexandra Smith

  23. The Children’s Hospital at Montefiore, Bronx, NY, USA

    Mamta Fuloria, Kimberly Reidy & Frederick J. Kaskel

  24. University of Colorado, Children’s Hospital Colorado, Aurora, CO, USA

    Danielle E. Soranno, Jason Gien & Katja M. Gist

  25. University of Kentucky, Lexington, KY, USA

    Aftab S. Chishti & Mina H. Hanna

  26. University of Washington, Seattle Children’s Hospital, Seattle, WA, USA

    Sangeeta Hingorani & Sandra Juul

  27. University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Craig S. Wong, Catherine Joseph, Tara DuPont, Robin Ohls & Amy Staples

  28. Kidney and Urology Institute Medant, The Medicity, Gurgaon, India

    Smriti Rohatgi & Sidharth K. Sethi

  29. Cloudnine Hospital, Gurgaon, Haryana, India

    Sanjay Wazir

  30. Apollo Cradle, Gurgaon, Haryana, India

    Surender Khokhar

  31. Children’s National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington, DC, USA

    Sofia Perazzo, Patricio E. Ray & Mary Revenis

  32. British Columbia Children’s Hospital, Vancouver, BC, Canada

    Cherry Mammen & Anne Synnes

  33. Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Pia Wintermark & Michael Zappitelli

  34. Stony Brook School of Medicine, Stony Brook, NY, USA

    Robert Woroniecki & Shanthy Sridhar

Authors
  1. Jennifer Chmielewski
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  2. Paulomi M. Chaudhry
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  3. Matthew W. Harer
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  4. Shina Menon
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  5. Andrew M. South
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  6. Ashley Chappell
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  7. Russell Griffin
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  8. David Askenazi
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  9. Jennifer Jetton
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  10. Michelle C. Starr
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Consortia

Neonatal Kidney Collaborative

  • Namasivayam Ambalavanan
  • , David T. Selewski
  • , Subrata Sarkar
  • , Alison Kent
  • , Jeffery Fletcher
  • , Carolyn L. Abitbol
  • , Marissa DeFreitas
  • , Shahnaz Duara
  • , Jennifer R. Charlton
  • , Jonathan R. Swanson
  • , Ronnie Guillet
  • , Carl D’Angio
  • , Ayesa Mian
  • , Erin Rademacher
  • , Maroun J. Mhanna
  • , Rupesh Raina
  • , Deepak Kumar
  • , Jennifer G. Jetton
  • , Patrick D. Brophy
  • , Tarah T. Colaizy
  • , Jonathan M. Klein
  • , Ayse Akcan Arikan
  • , Christopher J. Rhee
  • , Stuart L. Goldstein
  • , Amy T. Nathan
  • , Juan C. Kupferman
  • , Alok Bhutada
  • , Shantanu Rastogi
  • , Elizabeth Bonachea
  • , Susan Ingraham
  • , John Mahan
  • , Arwa Nada
  • , F. Sessions Cole
  • , T. Keefe Davis
  • , Joshua Dower
  • , Lawrence Milner
  • , Alexandra Smith
  • , Mamta Fuloria
  • , Kimberly Reidy
  • , Frederick J. Kaskel
  • , Danielle E. Soranno
  • , Jason Gien
  • , Katja M. Gist
  • , Aftab S. Chishti
  • , Mina H. Hanna
  • , Sangeeta Hingorani
  • , Sandra Juul
  • , Craig S. Wong
  • , Catherine Joseph
  • , Tara DuPont
  • , Robin Ohls
  • , Amy Staples
  • , Smriti Rohatgi
  • , Sidharth K. Sethi
  • , Sanjay Wazir
  • , Surender Khokhar
  • , Sofia Perazzo
  • , Patricio E. Ray
  • , Mary Revenis
  • , Cherry Mammen
  • , Anne Synnes
  • , Pia Wintermark
  • , Michael Zappitelli
  • , Robert Woroniecki
  •  & Shanthy Sridhar

Contributions

JC and MS conceptualized and designed the study, assisted with data analysis and interpretation, drafted the initial manuscript, and reviewed and revised the manuscript. AC and RG performed statistical analysis and reviewed and revised the manuscript. DA and JJ conceptualized and designed the study, provided support and mentorship, and reviewed and revised the manuscript. PC, MH, SM and AS assisted with the design of the study, data interpretation, and reviewed and revised the manuscript for important intellectual content. All authors approve the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Michelle C. Starr.

Ethics declarations

Competing interests

All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. For full disclosure, we provide the additional list of authors’ other funding not directly related to this study. DA consults for and received research/education grants with Baxter, Medtronic, Nuwellis, Bioporto and Seastar. He has patent pending inventions in the area of neonatal nephrology. AS reports receiving grant funding for studies not related to this work, grants NHLBI K23 HL148394, L40 HL148910, and R01 HL146818. MS is supported in part by the Indiana University School of Medicine Physician Scientist Initiative. No other disclosures were reported.

Ethics approval and consent to participate

The Institutional Review Board (IRB) at the University of Alabama at Birmingham approved this collaborative multicenter study, and each center received approval from their respective IRBs for participation. The study design allowed for a waiver of informed consent or parental permission. This study is registered with ClinicalTrials.org, number NCT02443389.

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Chmielewski, J., Chaudhry, P.M., Harer, M.W. et al. Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation. J Perinatol 42, 930–936 (2022). https://doi.org/10.1038/s41372-022-01424-3

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