The following is a summary of “Acute Kidney Injury Defined by Fluid-Corrected Creatinine in Premature Neonates, A Secondary Analysis of the PENUT Randomized Clinical Trial,” published in the August 2023 issue of Nephrology by Starrr et al.
Acute kidney injury (AKI) diagnosis in premature neonates is complicated by fluid balance; correcting serum creatinine may help. Researchers initiated a retrospective study investigating whether fluid balance-corrected serum creatinine could uncover additional neonatal AKI cases and modify the correlation between AKI and short/long-term outcomes.
They analyzed the Preterm Erythropoietin Neuroprotection Trial (PENUT), a phase 3 randomized clinical trial. The primary outcome was invasive mechanical ventilation on day 14. Secondary outcomes comprised mortality, hospital stay, and severe bronchopulmonary dysplasia (BPD). Categorical factors were evaluated with the χ2 or Fisher exact test. Continuous and ordinal variables were compared using a t-test and a Wilcoxon rank sums difficulty. Calculated Odds Ratios (ORs) and 95% CIs using logistic regression to study exposure’s link to outcomes.
The results showed 923 premature neonates (479 boys [51.9%]; median [IQR] birth weight, 801 [668-940] g). Among them, 215 (23.3%) were diagnosed with AKI based on uncorrected serum creatinine. After adjusting fluid balance, 13 neonates initially diagnosed with AKI became non-fluid-corrected, and 111 without AKI were reclassified as fluid-corrected AKI (unveiled AKI). Thus, fluid-corrected AKI was identified in 313 neonates (33.9%). Neonates with unveiled AKI had similar traits to those diagnosed with AKI based on uncorrected serum creatinine. AKI neonates had higher ventilation needs (81 [75.0%] vs. 254 [44.3%]), and longer hospital stays (median [IQR] 102 [84-124] days vs. 90 [71-110] days) than those without AKI. Multivariable analysis demonstrated that diagnosing fluid-corrected AKI was associated with elevated odds of adverse clinical outcomes, including ventilation (adjusted odds ratio [OR], 2.23; 95% confidence interval [CI], 1.56-3.18) and severe bronchopulmonary dysplasia (adjusted OR, 2.05; 95% CI, 1.15-3.64).
They concluded premature neonates face adverse clinical outcomes due to the underrepresentation of AKI in serum creatinine.
Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2808142
