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Original ArticlesAcute Kidney Injury
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Recognition and Reporting of AKI in Very Low Birth Weight Infants

J. Bryan Carmody, Jonathan R. Swanson, Erika T. Rhone and Jennifer R. Charlton
CJASN December 2014, 9 (12) 2036-2043; DOI: https://doi.org/10.2215/CJN.05190514
J. Bryan Carmody
*Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia; and
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Jonathan R. Swanson
†Department of Pediatrics, Division of Neonatology and
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Erika T. Rhone
‡Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia
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Jennifer R. Charlton
‡Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia
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    Figure 1.

    Identification, exclusion, and analysis of infants for the study.

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    Figure 2.

    AKI occurrence by gestational age among very low birth weight infants; 80% of infants who experienced AKI were born at <28 weeks gestational age, whereas 73% of infants who did not experience AKI were born at ≥28 weeks gestational age (odds ratio, 10.6; 95% confidence interval, 6.8 to 16.7; c statistic=0.76; 95% confidence interval, 0.72 to 0.81).

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    Table 1.

    Modified KDIGO definition of AKI used in the study

    AKI StageDefinition
    0No significant change in creatinine
    1↑ SCr by 0.3 mg/dl within 48 h or
    ↑ in SCr by 150% to <200% from previous trough
    2↑ in SCr by 200% to <300% of previous trough
    3↑ in SCr≥300% of previous trough or
    SCr≥2.5 mg/dl or
    RRT
    • SCr, serum creatinine.

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    Table 2.

    Patient demographics with mean testing for infants who did and did not experience AKI

    CharacteristicAll Patients (n=455)AKI (n=181)No AKI (n=274)P
    Mean (SD)RangeMean (SD)RangeMean (SD)Range
    Gestational age (wk)27.7 (3)22–3725.7 (2.4)22–3329.0 (2.6)24–37<0.001
    Birth weight (g)1016 (296)370–1495816 (253)370–14701148 (245)400–1495<0.001
    Sex (% boys)5154490.33
    Apgar (1 min)4.9 (2.7)0–94.0 (2.6)0–95.4 (2.5)0–9<0.001
    Apgar (5 min)6.9 (2.0)0–96.0 (2.2)0–97.4 (1.7)2–9<0.001
    SGA (%)2214260.002
    CRIB II scorea9.5 (3.9)2–1912.1 (3.6)3–197.6 (3.0)2–17<0.001
    Length of stay (d)68 (41)3–30795 (69–114)b3–30746 (31–69)b3–175<0.001
    Initial creatinine (mg/dl)0.74 (0.14)0.4–1.50.76 (0.15)0.4–1.10.72 (0.13)0.5–1.50.001
    Mortality (%)8143<0.001
    • SGA, small for gestational age; CRIB II, updated clinical risk index for babies score.

    • ↵a CRIB II scores were missing in 18.5% of patients. For all patients, n=371. For patients with AKI, n=157. For patients with no AKI, n=214.

    • ↵b All results are reported as mean and SD except length of stay, which is reported as median and interquartile range.

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    Table 3.

    Uni- and multivariable logistic regression analyses for mortality

    FactorOR95% CIP
    Univariable analyses
     AKI4.942.26 to 10.81<0.001
     Apgar (1 min)0.830.72 to 0.960.01
     Apgar (5 min)0.740.64 to 0.87<0.001
     Birth weight (100 g)0.810.72 to 0.920.001
     CRIB II1.171.06 to 1.290.001
     Gestational age (wk)0.800.70 to 0.920.001
     Preeclampsia0.600.18 to 2.010.41
     Race (non-Caucasian)1.170.58 to 2.350.66
     Sex (boys)1.710.84 to 3.480.14
     SGA0.900.38 to 2.140.82
    Multivariable analyses (final model)
     AKI4.001.39 to 11.520.01
     Birth weight (100 g)1.391.01 to 1.910.04
     CRIB II1.341.06 to 1.690.02
     SGA4.381.39 to 13.800.01
    • OR, odds ratio; 95% CI, 95% confidence interval; CRIB II, updated clinical risk index for babies; SGA, small for gestational age.

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    Table 4.

    Uni- and multivariable linear regression for length of stay (days)

    FactorDays95% CIP
    Univariable analyses
     AKI (occurrence)53.349.5 to 57.1<0.001
     AKI (stage 1 only)39.432.7 to 46.1<0.001
     AKI (no. of episodes)19.116.3 to 22.0<0.001
     Apgar (1 min)−3.6−4.9 to −2.3<0.001
     Apgar (5 min)−5.4−7.1 to −3.6<0.001
     Birth weight (100 g)−9.2−10.1 to −8.4<0.001
     CRIB II11.23.8 to 18.70.003
     Gestational age (wk)−9.4−10.3 to −8.6<0.001
     Preeclampsia−2.6−12.8 to 7.50.61
     Race (non-Caucasian)−1.7−8.9 to 5.50.64
     Sex (boys)3.3−3.7 to 10.40.36
     SGA−24.9−32.9 to −16.9<0.001
    Multivariable analyses (final models)
     AKI (occurrence)11.75.1 to 18.40.001
      Birth weight (100 g)−2.9−4.8 to −1.10.002
      CRIB II1.1−0.7 to 3.00.23
      Gestational age (wk)−5.1−7.6 to −2.6<0.001
     AKI (stage 1 only)5.4−0.8 to 11.50.09
      Birth weight (100 g)−2.0−3.6 to −0.30.02
      CRIB II1.90.3 to 3.60.02
      Gestational age (wk)−5.7−7.9 to −3.6<0.001
     AKI (no. of episodes)4.92.0 to 7.70.001
      Birth weight (100 g)−3.0−4.8 to −1.10.002
      CRIB II1.4−0.5 to 3.20.15
      Gestational age (wk)−4.8−7.3 to −2.3<0.001
    • CRIB II, updated clinical risk index for babies; SGA, small for gestational age.

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Clinical Journal of the American Society of Nephrology: 9 (12)
Clinical Journal of the American Society of Nephrology
Vol. 9, Issue 12
December 05, 2014
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Recognition and Reporting of AKI in Very Low Birth Weight Infants
J. Bryan Carmody, Jonathan R. Swanson, Erika T. Rhone, Jennifer R. Charlton
CJASN Dec 2014, 9 (12) 2036-2043; DOI: 10.2215/CJN.05190514

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Recognition and Reporting of AKI in Very Low Birth Weight Infants
J. Bryan Carmody, Jonathan R. Swanson, Erika T. Rhone, Jennifer R. Charlton
CJASN Dec 2014, 9 (12) 2036-2043; DOI: 10.2215/CJN.05190514
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