100 Systematic Review: What is the impact of acute kidney injury in the neonatal period on longer term renal outcomes?. (17th August 2022)

• Record Type: Journal Article
• Authors: Jacob, Zoe; Reynolds, Ben
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A90
• Page End: A91
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.145
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Though neonatal acute kidney injury (AKI) is increasingly recognised, the impact on future renal health is incompletely understood. Defining AKI in this age group is challenging due to unique and variable physiological states, complicated by prematurity, low birth weight and their associated co-morbidities. This systematic review analysed renal outcomes in patients who were diagnosed with neonatal AKI, to better understand the implications on longer term renal health. Methods: Ovid MEDLINE® ALL, EMBASE, MIDIRS, ERIC, NHS Scotland Journals, the Cochrane Central Register databases, clinical trials registers and relevant references were searched for eligible studies published from database inception until 28 th April 2021. Inclusion criteria: neonates, including preterm and extreme/very low birth weight (E/VLBW) infants, with a diagnosis of AKI in the neonatal period, whose renal function was assessed beyond the neonatal period. Exclusion criteria: Studies of patients with neonatal chronic kidney disease (CKD), congenital heart or urinary tract defects, or with <10 eligible patients. The studies were analysed and assessed for risk of bias using the CLARITY Group (McMaster University) 'Risk of Bias Tool'. Results: Of 678 articles identified at initial search, eight cohort studies were eligible for inclusion. Seven were found to have a moderate-high degree of bias in one or more areas. Study populations were ELBW/VLBW neonates (three studies), preterm versus term counterparts (two studies), AKI versus no-AKI groups (two studies) and AKI in neonates receiving ECMO (one study) totalling 895 patients. The age range for follow-up was six months to 18 years. The definition of AKI and markers of CKD varied between studies. The majority used estimated glomerular filtration rate (eGFR), proteinuria and/or systolic/diastolic blood pressure (S/DBP). Neonates with AKI had lower eGFR and higher levels of proteinuria compared to those without. Several studies reported evidence of hyperfiltration though definitions between studies varied. Two studies found no difference in serum creatinine levels between AKI and no-AKI groups. BP was elevated in AKI versus no-AKI groups, though often not statistically significant when adjusted for sex, age and height. The prevalence of elevated BP was greater than that of the general population in studies assessing ELBW, preterm infants and those receiving ECMO. One study concluded that only birth weight was associated with renal outcome. Another showed that the AKI group of VLBW infants were 4.5 times more likely to develop renal dysfunction than those without AKI. Another study reported that, regardless of the presence of absence of AKI, 64% of term neonates admitted to the NICU had derangement of one or more markers of renal function at follow-up. Conclusion: Challenges arise when determining what impact AKI will have on long-term renal health due to heterogeneous definitions for neonatal AKI and measures of renal dysfunction, alongside a lack of large population studies. AKI is linked with renal dysfunction at follow-up, whether the infant is within an at-risk group or not. We have opportunities to make a positive impact; prevention strategies, identifying and treating AKI early, and following up at-risk patients to detect and manage renal dysfunction early.