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Acute Kidney Injury is Associated with Poor Lung Outcomes in Infants Born ≥32 Weeks of Gestational AgeFunding 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 two of the AWAKEN study investigators at UAB (D.A., R.G., and L.B.). 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.
02 May 2019
10 September 2019
18 November 2019 (online)
Objective This study aimed to evaluate the association between acute kidney injury (AKI) and lung outcomes in infants born ≥32 weeks of gestational age (GA).
Study Design Secondary analysis of infants ≥32 weeks of GA in the assessment of worldwide acute kidney injury epidemiology in neonates (AWAKEN) retrospective cohort (n = 1,348). We used logistic regression to assess association between AKI and a composite outcome of chronic lung disease (CLD) or death at 28 days of age and linear regression to evaluate association between AKI and duration of respiratory support.
Results CLD occurred in 82/1,348 (6.1%) infants, while death occurred in 22/1,348 (1.6%); the composite of CLD/death occurred in 104/1,348 (7.7%). Infants with AKI had an almost five-fold increased odds of CLD/death, which remained after controlling for GA, maternal polyhydramnios, multiple gestations, 5-minute Apgar's score, intubation, and hypoxic–ischemic encephalopathy (adjusted odds ratio [OR] = 4.9, 95% confidence interval [CI]: 3.2–7.4; p < 0.0001). Infants with AKI required longer duration of respiratory support (count ratio = 1.59, 95% CI: 1.14–2.23, p = 0.003) and oxygen (count ratio = 1.43, 95% CI: 1.22–1.68, p < 0.0001) compared with those without AKI.
Conclusion AKI is associated with CLD/death and longer duration of respiratory support in infants born at ≥32 weeks of GA. Further prospective studies are needed to elucidate the pathophysiologic relationship.
Keywordsacute kidney injury - acute renal failure - acute lung injury - chronic lung disease - organ crosstalk - neonate
Neonatal Kidney Collaborative Contributors
The following individuals served as collaborators and site investigators for the AWAKEN study. They collaborated in protocol development and review, local IRB submission, data collection, and participated in drafting or review of the manuscript.
Namasivayam Ambalavanan, MD—Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL.
David T. Selewski, MD, Medical University of South Carolina, Charleston, SC.
Subrata Sarkar, MD—C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Alison Kent, MD, Medical University of South Carolina, Charleston, SC.
Jeffery Fletcher, PhD—Centenary Hospital for Women and Children, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
Carolyn L. Abitbol, MD, Marissa DeFreitas, MD, Shahnaz Duara, MD—Holtz Children's Hospital, University of Miami, Miami, FL.
Jennifer R. Charlton, MD, Jonathan R. Swanson MD—University of Virginia Children's Hospital, Charlottesville, VA.
Ronnie Guillet, MD, Carl D'Angio, MD, Ayesa Mian, MD, Erin Rademacher, MD—Golisano Children's Hospital, University of Rochester, Rochester, NY.
Maroun J. Mhanna, MD, Rupesh Raina, MD, Deepak Kumar, MD—MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
Jennifer G. Jetton, MD, Patrick D. Brophy, MD, Tarah T. Colaizy, MD, Jonathan M. Klein, MD—University of Iowa Children's Hospital, Iowa City, IA.
Ayse Akcan Arikan, MD, Christopher J. Rhee, MD—Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Stuart L. Goldstein, MD, Amy T. Nathan, MD—Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Juan C. Kupferman, MD, Alok Bhutada, MD, Shantanu Rastogi, MD — Maimonides Medical Center, Brooklyn, NY.
Elizabeth Bonachea, MD, John Mahan, MD— Nationwide Children's Hospital, Columbus, OH.
F. Sessions Cole, MD, T. Keefe Davis, MD—Washington University, St. Louis, MO.
Joshua Dower, MD, Lawrence Milner, MD, Alexandra Smith, MD—Tufts University School of Medicine, Boston, MA.
Mamta Fuloria, MD, Kimberly Reidy, MD, Frederick J. Kaskel, MD—The Children's Hospital at Montefiore, Bronx, NY.
Danielle E. Soranno, MD Jason Gien, MD, Katja M. Gist, DO—University of Colorado, Children's Hospital Colorado, Aurora, CO.
Aftab S. Chishti, MD, Mina H. Hanna, MD—University of Kentucky, Lexington, KY.
Craig S. Wong, MD, Catherine Joseph, MD, Tara DuPont, MD, Robin Ohls, MD, Amy Staples, MD—University of New Mexico Health Sciences Center, Albuquerque, NM.
Surender Khokhar, MD—Apollo Cradle, Gurgaon, Haryana, India.
Sofia Perazzo, MD, Patricio E. Ray, Mary Revenis, MD—Children's National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington DC.
Sidharth K. Sethi, MD, Smriri Rohatgi, MD—Medanta, The Medicity, Gurgaon, Haryana, India.
Cherry Mammen, MD, Anne Synnes, MDCM—British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Sanjay Wazir, MD—Cloudnine Hospital, Gurgaon, Haryana, India.
Pia Wintermark, MD—Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Robert Woroniecki, MD, Shanty Sridhar, MD—Stony Brook School of Medicine, Stony Brook, NY.
Susan Ingraham, MD—Kapi'olani Medical Center for Women and Children John A. Burns School of Medicine, University of Hawaii, HI.
Arwa Nada, MD—Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Michael Zappitelli, MD—Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
The authors would also like to thank the outstanding work of the following clinical research personnel and colleagues for their involvement in AWAKEN:
Ariana Aimani, Samantha Kronish, Ana Palijan, MD, Michael Pizzi—Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Laila Ajour, BS, Julia Wrona, BS—University of Colorado, Children's Hospital Colorado, Aurora, CO; Melissa Bowman, RN—University of Rochester, Rochester, NY; Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse Cristina Pareja Valarezo, MD—Holtz Children's Hospital, University of Miami, Miami, FL; Sarah Cashman, BS, Madeleine Stead, BS—University of Iowa Children's Hospital, Iowa City, IA; Jonathan Davis, MD, Julie Nicoletta, MD—Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA; Alanna DeMello—British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Lynn Dill, RN—University of Alabama at Birmingham, Birmingham, AL; Ellen Guthrie, RN—MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; Nicholas L. Harris, BS, Susan M. Hieber, MSQM—C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Katherine Huang, Rosa Waters—University of Virginia Children's Hospital, Charlottesville, VA; Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell—Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Nilima Jawale, MD—Maimonides Medical Center, Brooklyn, NY; Emily Kane—Australian National University, Canberra, Australia; Vijay Kher, DM, Puneet Sodhi, MBBS—Medanta Kidney Institute, The Medicity Hospital, Gurgaon, Haryana, India; Grace Mele—New York College of Osteopathic Medicine, Westbury, NY; Patricia Mele, DNP—Stony Brook Children's Hospital, Stony Brook, NY; Charity Njoku, Tennille Paulsen, Sadia Zubair—Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Emily Pao—University of Washington, Seattle Children's Hospital, Seattle, WA; Becky Selman RN, Michele Spear, CCRC—University of New Mexico Health Sciences Center Albuquerque, NM; Melissa Vega, PA-C—The Children's Hospital at Montefiore, Bronx, NY; Leslie Walther RN—Washington University, St. Louis, MO.
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