Sangeeta Hingorani1,2,3, Robert H Schmicker2, Patrick D Brophy4, Patrick J Heagerty2, Sandra E Juul3,5, Stuart L Goldstein6, David Askenazi7. 1. Division of Nephrology, Seattle Children's Hospital and University of Washington, Seattle, Washington sangeeta.hingorani@seattlechildrens.org. 2. Department of Biostatistics, University of Washington, Seattle, Washington. 3. Department of Pediatrics, University of Washington, Seattle, Washington. 4. Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York. 5. Division of Neonatology, Seattle Children's Hospital and University of Washington, Seattle, Washington. 6. Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and The University of Cincinnati College of Medicine, Cincinnati, Ohio. 7. Division of Nephrology, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama.
Abstract
BACKGROUND AND OBJECTIVES: AKI is associated with poor short- and long-term outcomes. Questions remain about the frequency and timing of AKI, and whether AKI is a cause of death in extremely low gestational age neonates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Recombinant Erythropoietin for Protection of Infant Kidney Disease Study examines the kidney outcomes of extremely low gestational age neonates enrolled in the Preterm Epo Neuroprotection study, a randomized, placebo-controlled trial of recombinant human erythropoietin. We included 900 of 941 patients enrolled in Preterm Epo Neuroprotection. Baseline characteristics were compared by primary exposure (severe AKI versus none/stage 1 AKI) using unadjusted logistic regression models. Cox regression models estimated the relationship between severe AKI and death after adjustment for potential confounders. Time-dependent AKI was modeled as a binary outcome and a categorical variable by stage of AKI. We fit Cox models using time-dependent AKI status lagged by <7 days before death. Landmark analyses examined the relationship of death with development of severe AKI. RESULTS: Severe AKI occurred in 168 of 900 (19%, 95% confidence interval, 17% to 20%) neonates, and stage 3 AKI occurred in 60 (7%, 95% confidence interval, 5% to 8%). Stage 3 AKI occurring 7 days before death (hazard ratio, 3.88; 95% confidence interval, 1.26 to 11.96), intraventricular hemorrhage (hazard ratio, 2.01; 95% confidence interval, 1.01 to 3.99) and sepsis (hazard ratio, 2.85; 95% confidence interval, 1.12 to 7.22) were all independently associated with death. Severe AKI occurring 7 days before death (hazard ratio, 2.21; 95% confidence interval, 0.92 to 5.26) was associated with death but not statistically significant. In a landmark analysis, after adjusting for potential confounders, late (after day 14 and before day 28) severe AKI was strongly associated with higher hazard of death (hazard ratio, 4.57; 95% confidence interval, 1.82 to 11.5). CONCLUSIONS: Severe AKI occurs frequently in extremely low gestational age neonates. Stage 3 AKI is associated with mortality, and this association is present 7 days before death.
BACKGROUND AND OBJECTIVES: AKI is associated with poor short- and long-term outcomes. Questions remain about the frequency and timing of AKI, and whether AKI is a cause of death in extremely low gestational age neonates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Recombinant Erythropoietin for Protection of Infant Kidney Disease Study examines the kidney outcomes of extremely low gestational age neonates enrolled in the Preterm Epo Neuroprotection study, a randomized, placebo-controlled trial of recombinant human erythropoietin. We included 900 of 941 patients enrolled in Preterm Epo Neuroprotection. Baseline characteristics were compared by primary exposure (severe AKI versus none/stage 1 AKI) using unadjusted logistic regression models. Cox regression models estimated the relationship between severe AKI and death after adjustment for potential confounders. Time-dependent AKI was modeled as a binary outcome and a categorical variable by stage of AKI. We fit Cox models using time-dependent AKI status lagged by <7 days before death. Landmark analyses examined the relationship of death with development of severe AKI. RESULTS: Severe AKI occurred in 168 of 900 (19%, 95% confidence interval, 17% to 20%) neonates, and stage 3 AKI occurred in 60 (7%, 95% confidence interval, 5% to 8%). Stage 3 AKI occurring 7 days before death (hazard ratio, 3.88; 95% confidence interval, 1.26 to 11.96), intraventricular hemorrhage (hazard ratio, 2.01; 95% confidence interval, 1.01 to 3.99) and sepsis (hazard ratio, 2.85; 95% confidence interval, 1.12 to 7.22) were all independently associated with death. Severe AKI occurring 7 days before death (hazard ratio, 2.21; 95% confidence interval, 0.92 to 5.26) was associated with death but not statistically significant. In a landmark analysis, after adjusting for potential confounders, late (after day 14 and before day 28) severe AKI was strongly associated with higher hazard of death (hazard ratio, 4.57; 95% confidence interval, 1.82 to 11.5). CONCLUSIONS: Severe AKI occurs frequently in extremely low gestational age neonates. Stage 3 AKI is associated with mortality, and this association is present 7 days before death.
Authors: Matthew W Harer; David T Selewski; Kianoush Kashani; Rajit K Basu; Katja M Gist; Jennifer G Jetton; Scott M Sutherland; Michael Zappitelli; Stuart L Goldstein; Theresa Ann Mottes; David J Askenazi Journal: J Perinatol Date: 2020-09-05 Impact factor: 2.521
Authors: Jennifer R Charlton; Louis Boohaker; David Askenazi; Patrick D Brophy; Mamta Fuloria; Jason Gien; Russell Griffin; Sangeeta Hingorani; Susan Ingraham; Ayesa Mian; Robin K Ohls; Shantanu Rastogi; Christopher J Rhee; Mary Revenis; Subrata Sarkar; Michelle Starr; Alison L Kent Journal: Pediatr Res Date: 2018-12-13 Impact factor: 3.756
Authors: David J Askenazi; Patrick J Heagerty; Robert H Schmicker; Patrick Brophy; Sandra E Juul; Stuart L Goldstein; Sangeeta Hingorani Journal: J Pediatr Date: 2021-01-20 Impact factor: 4.406
Authors: Jennifer G Jetton; Louis J Boohaker; Sidharth K Sethi; Sanjay Wazir; Smriti Rohatgi; Danielle E Soranno; Aftab S Chishti; Robert Woroniecki; Cherry Mammen; Jonathan R Swanson; Shanty Sridhar; Craig S Wong; Juan C Kupferman; Russell L Griffin; David J Askenazi Journal: Lancet Child Adolesc Health Date: 2017-11
Authors: David Askenazi; Carolyn Abitbol; Louis Boohaker; Russell Griffin; Rupesh Raina; Joshua Dower; T Keefe Davis; Patricio E Ray; Sofia Perazzo; Marissa DeFreitas; Lawrence Milner; Namasivayam Ambalavanan; F Sessions Cole; Erin Rademacher; Michael Zappitelli; Maroun Mhanna Journal: Pediatr Res Date: 2018-12-13 Impact factor: 3.756