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  • Clinical Research Article
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Preceding risks and mortality outcomes of different neonatal acute kidney injury in preterm infants

Pediatric Research volume 94, pages 1530–1537 (2023)Cite this article

Abstract

Background

The aim of the study was to examine preceding risks and mortality outcomes of oliguric and non-oliguric acute kidney injury (AKI) in very preterm infants.

Methods

Infants born ≤30 weeks’ gestation were included. AKI was diagnosed based on neonatal Kidney Disease: Improving Global Outcomes criteria and was classified as oliguric and non-oliguric according to the urine-output criteria. We used modified Poisson and Cox proportional-hazards models for statistical comparisons.

Results

Of 865 enrolled infants (gestational age 27.2 ± 2.2 weeks and birth weight 983 ± 288 gm), 204 (23.6%) developed AKI. Before AKI, the oliguric AKI group had significantly higher prevalence of small-for-gestational age (p = 0.008), lower 5-min Apgar score (p = 0.009) and acidosis (p = 0.009) on admission, and hypotension (p = 0.008) and sepsis (p = 0.001) during admission than the non-oliguric AKI group. Oliguric (adjusted risk ratio 3.58, 95% CI 2.33–5.51; adjusted hazard ratio 4.93, 95% CI 3.14–7.72) instead of non-oliguric AKI had significantly higher mortality risks than no AKI. Oliguric AKI showed significantly higher mortality risks than non-oliguric AKI, irrespective of serum creatinine and severity of AKI.

Conclusions

Categorizing AKI as oliguric and non-oliguric was crucial because of the distinct preceding risks and mortality outcomes of these two types of AKI in very preterm neonates.

Impact

  • The differences of the underlying risks and prognosis between oliguric and non-oliguric AKI in very preterm infants remain unclear.

  • We found that oliguric AKI, but not non-oliguric AKI, carries higher mortality risks than infants without AKI. Oliguric AKI possessed higher mortality risks than non-oliguric AKI, irrespective of concomitant serum creatinine elevation and severe AKI.

  • Oliguric AKI is more associated with prenatal small-for-the-gestational age and perinatal and postnatal adverse events, while non-oliguric AKI is associated with nephrotoxins exposures.

  • Our finding highlighted the importance of oliguric AKI and is helpful in developing future protocol in neonatal critical care.

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Data availability

The corresponding author had full access to the dataset used and analyzed during the current study. The datasets used during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the Taiwan Premature Baby Foundation and all team members in charge of data collection. None of these individuals were compensated for their contributions.

Funding

This study was supported by the grants from Taiwan Ministry of Science and Technology (MOST 110-2314-B-006-057, MOST-110-2314-B-006-113, MOST-109-2314-B-006-008) and from National Cheng Kung University Hospital (NCKUH-11001002, NCKUH-11101001).

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Authors and Affiliations

  1. Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan

    Chih-Chia Chen

  2. Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chih-Chia Chen, Yung-Chieh Lin & Chao-Ching Huang

  3. Department of Statistics, Tunghai University, Taichung, Taiwan

    Chi-Hsiang Chu

  4. Graduate Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Shan-Tair Wang

  5. Division of Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

    Shan-Tair Wang

  6. Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chao-Ching Huang

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Contributions

C.-C.C. and C.-C.H. contributed to research idea and study design; Y.-C.L. contributed to data acquisition; C.-C.C., C.-H.C., Y.-C.L., S.-T.W., and C.-C.H. contributed to data analysis/interpretation; C.-C.C., C.-H.C., and S.-T.W. provided statistical analysis; S.T.W. and C.C.H. provided supervision or mentorship. All authors contributed important intellectual content during manuscript drafting or revision.

Corresponding author

Correspondence to Chao-Ching Huang.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the ethics review board of National Cheng-Kung University Hospital (A-BR-108-013, and ER-98-135). The informed consent of participants born after August 13, 2009 was obtained and that of infants born previously were waived.

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Chen, CC., Chu, CH., Lin, YC. et al. Preceding risks and mortality outcomes of different neonatal acute kidney injury in preterm infants. Pediatr Res 94, 1530–1537 (2023). https://doi.org/10.1038/s41390-023-02650-x

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