A RECENT cohort study has shed light on recurrent acute kidney injury (rAKI) in critically ill neonates, uncovering its incidence, risk factors, and clinical outcomes.
Conducted as a secondary analysis of the AWAKEN retrospective study, the research examined data from 24 neonatal intensive care units across multiple countries. The cohort comprised 2,162 neonates, predominantly male, admitted between 1 January–31 March 2014. Among them, 605 experienced acute kidney injury (AKI), with 133 subsequently developing rAKI.
Key findings illuminated that neonates with rAKI exhibited distinct risk factors, including younger gestational age, lower birth weight, and a higher initial AKI stage. Notably, infants with rAKI faced a significantly prolonged median length of stay compared to those with a single AKI episode, highlighting the clinical ramifications of recurrent injury. The median length of stay for neonates with rAKI was 60 days, compared to 17 days for those without AKI and 18 days for those with a single episode.
The study also employed time-varying Cox proportional hazards regression models, revealing that rAKI independently correlated with a lower likelihood of discharge when compared to single AKI episodes. However, mortality rates did not significantly differ between the two groups.
These findings underscore the imperative for heightened vigilance and targeted interventions in neonates at risk of rAKI, emphasising the need for continued research and clinical monitoring post-initial AKI episode. Commenting on the limitations, however, the researchers noted the dataset’s static nature, reliance on serum creatinine and urine output data availability for rAKI analysis, and a conservative definition of recurrent rAKI. Increased monitoring may lead to higher recognition of AKI and potentially lower recurrence rates due to early intervention with kidney-protective strategies.
Reference:
Rutledge AD et al. Incidence, risk factors, and outcomes associated with recurrent neonatal acute kidney injury in the AWAKEN study. JAMA Netw Open. 2024;DOI:10.1001/jamanetworkopen.2023.55307.
