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Trends and racial disparities for acute kidney injury in premature infants: the US national database

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Abstract

Background

To assess prevalence and outcomes of acute kidney injury (AKI) in very-low-birth-weight infants.

Methods

This cross-sectional study utilized the National Inpatient Sample (NIS) dataset for years 2000–2017. All premature infants with birth weight (BW) <1500g and/or gestational age (GA) ≤32 weeks were included. Analyses were conducted for overall population and two BW categories: <1000g and 1000–1499g. Adjusted odds ratios were calculated after controlling for confounding variables in logistic regression analysis. Cochrane–Armitage test was used to assess for statistically significant trends in AKI frequency over the years.

Results

In total, 1,311,681 hospitalized premature infants were included; 19,603 (1.5%) were diagnosed with AKI. The majority (74.3%) were BW <1000g and 63.9% ≤28 weeks gestation. Prevalence of AKI differed by ethnicity; White had significantly less AKI than Black (OR=0.79, p<0.001) and Hispanic (OR=0.83, p<0.001). AKI was significantly associated with higher mortality compared to controls (35.1 vs. 3.0%, p<0.001). AKI was associated with comorbidities such as necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage, and septicemia. In a regression model, AKI was associated with higher mortality after controlling confounding factors (aOR=7.79, p<0.001). AKI was associated with significant increase in length of stay (p<0.001) and cost of hospitalization in survivors (p<0.001). There is a significant trend for increased AKI frequency over the years (Z score=4.33, p<0.001).

Conclusion

AKI is associated with increased mortality and comorbidities in preterm infants, especially in infants with BW <1000g. Further studies are needed to understand precipitating factors and assess preventative measures for this serious complication.

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Abbreviations

AKI:

acute kidney injury

BPD:

bronchopulmonary dysplasia

BW:

birth weight

GA:

gestational age

IVH:

intraventricular hemorrhage

NEC:

necrotizing enterocolitis

ROP:

retinopathy of prematurity

PDA:

patent ductus arteriosus

SGA:

small for gestational age

VLBW:

very low birth weight infants

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Authors and Affiliations

  1. Department of Neonatology, Cleveland Clinic Children’s, 900 Euclid Avenue, M31-37, Cleveland, OH, 44195, USA

    Marwa M. Elgendy, Mira Younis, Subhash Puthuraya & Hany Aly

  2. Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, MI, USA

    Hasan F. Othman

  3. Department of Pediatric Nephrology, Cleveland Clinic Children’s, Cleveland, OH, USA

    Raed Bou Matar

Authors
  1. Marwa M. Elgendy
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  2. Hasan F. Othman
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  3. Mira Younis
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  4. Subhash Puthuraya
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  5. Raed Bou Matar
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  6. Hany Aly
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Contributions

Drs. Elgendy and Aly conceptualized and designed the study, interpreted the statistical analyses, drafted the initial manuscript, reviewed and revised the manuscript, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. Dr. Younis and Puthuraya contributed to the design and concept of the manuscript, and assisted in drafting and revising the manuscript. Dr. Othman conceptualized and designed the study, carried out the initial analyses, and critically reviewed the manuscript for important intellectual content. Bou Matar reviewed the results and statistical work; he critically reviewed, edited, and approved the final version of the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Marwa M. Elgendy.

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The authors declare no competing interests.

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Elgendy, M.M., Othman, H.F., Younis, M. et al. Trends and racial disparities for acute kidney injury in premature infants: the US national database. Pediatr Nephrol 36, 2789–2795 (2021). https://doi.org/10.1007/s00467-021-04998-w

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  • DOI: https://doi.org/10.1007/s00467-021-04998-w

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