ORIGINAL ARTICLE
Incidence, risk factors, and outcome of neonatal acute kidney injury:
a prospective cohort study
Mohamed A. Shalaby
1
&
Zinab A. Sawan
2
&
Esraa Nawawi
2
&
Saad Alsaedi
3
&
Heidi Al-Wassia
3
&
Jameela A. Kari
1
Received: 4 July 2017 / Revised: 23 March 2018 / Accepted: 26 March 2018
#
IPNA 2018
Abstract
Background Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is
associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease.
Objectives To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU.
Methods This single-center prospective cohort study included all infants who received level II or III NICU care during 2015
(January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal
anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO)
criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included
mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence
interval (95% CI).
Results The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without
AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32
± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3–9) and perinatal
depression (RR, 10; 95% CI, 2–46) were significantly associated with an increased risk of AKI. For infants with gestational age
< 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95%
CI, 1–3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2–14), but not
with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference:
14 days; 95% CI, 5.5–23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels
(> 65 μmol/L).
Conclusion AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a
higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after
discharge is warranted in such infants.
Keywords AKI
.
NICU
.
Outcome
.
Mortality
.
Length of hospital stay
* Zinab A. Sawan
zenab.a.sawan@gmail.com
Mohamed A. Shalaby
mshalaby1977@hotmail.com
Esraa Nawawi
Esraa-Nawawi@hotmail.com
Saad Alsaedi
salsaedi@hotmail.com
Heidi Al-Wassia
halwassia@kau.edu.sa
Jameela A. Kari
jkari@kau.edu.sa; jkari@doctors.org.uk
1
Pediatric Nephrology Center of Excellence, King Abdulaziz
University, Jeddah, Kingdom of Saudi Arabia
2
Department of Pediatrics, King Abdulaziz University, PO Box 80215,
Jeddah 21589, Kingdom of Saudi Arabia
3
Neonatal Intensive Care Unit, King Abdulaziz University,
Jeddah, Kingdom of Saudi Arabia
Pediatric Nephrology
https://doi.org/10.1007/s00467-018-3966-7
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