Evaluation of acute kidney injury in preterm infants using serum creatinine decline in comparison with KDIGO criteria.

IF 2.6 3区 医学 Q1 PEDIATRICS
Pediatric Nephrology Pub Date : 2025-11-01 Epub Date: 2025-06-14 DOI:10.1007/s00467-025-06855-6
Yoong-A Suh, Seong Wan Kim, Seoheui Choi, Jang Hoon Lee, Moon Sung Park, Peong Gang Park
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引用次数: 0

Abstract

Background: Acute kidney injury (AKI) is commonly observed in critically ill neonates; however, early identification of AKI in the first week of life is challenging due to the influence of maternal serum creatinine (SCr). An alternative criterion proposed by Gupta et al. based on SCr decline may identify additional infants at risk beyond the KDIGO definition.

Methods: We retrospectively reviewed 409 infants with a gestational age < 32 weeks who were admitted to our NICU between 2018 and 2024. AKI was defined according to the KDIGO guidelines or the Gupta threshold for days 3, 5, or 7 SCr. We compared mortality, bronchopulmonary dysplasia (BPD), and length of hospital stay among the No-AKI, Gupta-only AKI, and KDIGO-AKI groups.

Results: Among 409 infants, 145 (35.5%) had Gupta-only AKI, 9 (2.2%) had KDIGO-only AKI, and 54 (13.2%) had both definitions. The infants with AKI were premature and had lower birth weights than those without AKI. Both AKI groups showed higher rates of composite outcomes (mortality or BPD) than the No-AKI (p < 0.001) group. Gupta-only AKI was associated with prolonged stay (+ 10.1 days, p = 0.01) and increased odds of BPD (adjusted OR 2.12, p = 0.023), while KDIGO-AKI had a stronger association with mortality (27.0%, p < 0.001).

Conclusions: The Gupta definition identified a substantial subset of highly preterm infants at a higher risk of adverse outcomes who were missed using the KDIGO criteria. Integrating SCr level decline-based methods may improve early AKI detection and enhance outcomes in this vulnerable population.

用血清肌酐下降与KDIGO标准比较评价早产儿急性肾损伤。
背景:急性肾损伤(AKI)常见于危重新生儿;然而,由于母亲血清肌酐(SCr)的影响,在出生后第一周早期识别AKI是具有挑战性的。Gupta等人基于SCr下降提出的另一种标准可以识别出KDIGO定义之外的其他危险婴儿。方法:我们回顾性分析了409例胎龄婴儿。结果:在409例婴儿中,145例(35.5%)为单纯gupta - AKI, 9例(2.2%)为单纯kdigo - AKI, 54例(13.2%)为两种定义。与没有AKI的婴儿相比,患有AKI的婴儿是早产儿,出生体重更低。两个AKI组的综合结局(死亡率或BPD)均高于无AKI组(p)。结论:Gupta定义确定了大量具有较高不良结局风险的高度早产儿,这些早产儿使用KDIGO标准未被发现。整合基于SCr水平下降的方法可以改善AKI的早期检测,并提高易感人群的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatric Nephrology
Pediatric Nephrology 医学-泌尿学与肾脏学
CiteScore
4.70
自引率
20.00%
发文量
465
审稿时长
1 months
期刊介绍: International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.
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