Arwa Nada1, David Askenazi2, Juan C Kupferman3, Maroun Mhanna4, John D Mahan5, Louis Boohaker2, Linzi Li2, Russell L Griffin6. 1. Department of Pediatrics, Division of Nephrology & Hypertension, Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, 49 North Dunlap St FOB 326, Memphis, TN, 38105, USA. anada@uthsc.edu. 2. Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA. 3. Department of Pediatrics, Division of Pediatric Nephrology & Hypertension, Maimonides Medical Center, Brooklyn, NY, USA. 4. Department of Pediatrics, Division of Neonatology, Louisiana State University Health in Shreveport, Shreveport, LA, USA. 5. Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA. 6. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Abstract
BACKGROUND: Data from adult and pediatric literature have shown an association between albumin levels and AKI. Whether hypoalbuminemia and neonatal AKI are associated has not been studied. METHODS: We evaluated the association of albumin with early (during the first postnatal week) and late (after the first postnatal week) AKI for 531 neonates from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database and for 3 gestational age (GA) subgroups: < 29, 29 to < 36, and ≥ 36 weeks GA. RESULTS: Low albumin levels were associated with increased odds of neonatal AKI; for every 0.1 g/dL decrease in albumin, the odds of late AKI increased by 12% on continuous analysis. After adjustment for potential confounders, neonates with albumin values in the lowest quartiles (< 2.2 g/dL) had an increased odds of early [Adjusted Odd Ratio (AdjOR) 2.5, 95% CI = 1.1-5.3, p < 0.03] and late AKI [AdjOR 13.4, 95% CI = 3.6-49.9, p < 0.0001] compared to those with albumin in the highest quartile (> 3.1 g/dL). This held true for albumin levels 2.3 to 2.6 g/dL for early [AdjOR 2.5, 95% CI = 1.2-5.5, p < 0.02] and late AKI [AdjOR 6.4, 95% CI = 1.9-21.6, p < 0.01]. Albumin quartiles of (2.7 to 3.0 g/dL) were associated with increased odds of late AKI. Albumin levels of 2.6 g/dL and 2.4 g/dL best predicted early (AUC = 0.59) and late AKI (AUC = 0.64), respectively. Analysis of albumin association with AKI by GA is described. CONCLUSIONS: Low albumin levels are independently associated with early and late neonatal AKI. Albumin could be a potential modifiable risk factor for neonatal AKI.
BACKGROUND: Data from adult and pediatric literature have shown an association between albumin levels and AKI. Whether hypoalbuminemia and neonatal AKI are associated has not been studied. METHODS: We evaluated the association of albumin with early (during the first postnatal week) and late (after the first postnatal week) AKI for 531 neonates from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database and for 3 gestational age (GA) subgroups: < 29, 29 to < 36, and ≥ 36 weeks GA. RESULTS: Low albumin levels were associated with increased odds of neonatal AKI; for every 0.1 g/dL decrease in albumin, the odds of late AKI increased by 12% on continuous analysis. After adjustment for potential confounders, neonates with albumin values in the lowest quartiles (< 2.2 g/dL) had an increased odds of early [Adjusted Odd Ratio (AdjOR) 2.5, 95% CI = 1.1-5.3, p < 0.03] and late AKI [AdjOR 13.4, 95% CI = 3.6-49.9, p < 0.0001] compared to those with albumin in the highest quartile (> 3.1 g/dL). This held true for albumin levels 2.3 to 2.6 g/dL for early [AdjOR 2.5, 95% CI = 1.2-5.5, p < 0.02] and late AKI [AdjOR 6.4, 95% CI = 1.9-21.6, p < 0.01]. Albumin quartiles of (2.7 to 3.0 g/dL) were associated with increased odds of late AKI. Albumin levels of 2.6 g/dL and 2.4 g/dL best predicted early (AUC = 0.59) and late AKI (AUC = 0.64), respectively. Analysis of albumin association with AKI by GA is described. CONCLUSIONS: Low albumin levels are independently associated with early and late neonatal AKI. Albumin could be a potential modifiable risk factor for neonatal AKI.
Authors: L Cataldi; R Leone; U Moretti; B De Mitri; V Fanos; L Ruggeri; G Sabatino; F Torcasio; V Zanardo; G Attardo; F Riccobene; C Martano; D Benini; L Cuzzolin Journal: Arch Dis Child Fetal Neonatal Ed Date: 2005-11 Impact factor: 5.747
Authors: Fatih Bolat; Serdar Comert; Guher Bolat; Oznur Kucuk; Emrah Can; Ali Bulbul; Hasan Sinan Uslu; Asiye Nuhoglu Journal: World J Pediatr Date: 2013-11-14 Impact factor: 2.764
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 T Selewski; Ayse Akcan-Arikan; Elizabeth M Bonachea; Katja M Gist; Stuart L Goldstein; Mina Hanna; Catherine Joseph; John D Mahan; Arwa Nada; Amy T Nathan; Kimberly Reidy; Amy Staples; Pia Wintermark; Louis J Boohaker; Russell Griffin; David J Askenazi; Ronnie Guillet Journal: Pediatr Res Date: 2018-09-20 Impact factor: 3.756
Authors: Jennifer G Jetton; Ronnie Guillet; David J Askenazi; Lynn Dill; Judd Jacobs; Alison L Kent; David T Selewski; Carolyn L Abitbol; Fredrick J Kaskel; Maroun J Mhanna; Namasivayam Ambalavanan; Jennifer R Charlton Journal: Front Pediatr Date: 2016-07-19 Impact factor: 3.418
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