Abby M Basalely1,2, Russell Griffin3, Katja M Gist4, Ronnie Guillet5, David J Askenazi3, Jennifer R Charlton6, David T Selewski7, Mamta Fuloria8, Frederick J Kaskel9, Kimberly J Reidy9. 1. Division of Pediatric Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA. abasalely@northwell.edu. 2. Division of Nephrology, Department of Pediatrics, The Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA. abasalely@northwell.edu. 3. Pediatric and Infant Center for Acute Nephrology (PICAN) Department of Pediatrics, University of Alabama, Birmingham, AL, USA. 4. Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 5. Division of Neonatology, University of Rochester Medical Center, Rochester, NY, USA. 6. Division of Nephrology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA. 7. Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA. 8. Division of Pediatric Neonatology, Department of Pediatrics, The Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA. 9. Division of Nephrology, Department of Pediatrics, The Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA.
Abstract
OBJECTIVE: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality. STUDY DESIGN: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models. RESULT: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07-4.31), hypernatremia (HR 4.23, 95% CI 2.07-8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01-14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI. CONCLUSION: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.
OBJECTIVE: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality. STUDY DESIGN: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models. RESULT: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07-4.31), hypernatremia (HR 4.23, 95% CI 2.07-8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01-14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI. CONCLUSION: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.
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