Caffeine and kidney function at two years in former extremely low gestational age neonates

Area of Science:

• Neonatalogy
• Pediatric Nephrology
• Critical Care Medicine

Background:

• Extremely low gestational age neonates (ELGANs) face risks for chronic kidney disease.
• The long-term renal effects of neonatal caffeine administration are not well understood.
• This study investigates the impact of prolonged caffeine exposure on kidney function in ELGANs.

Purpose of the Study:

• To determine the association between the duration of neonatal caffeine exposure and kidney function at 22-26 months corrected age in ELGANs.
• To explore whether bronchopulmonary dysplasia (BPD) status modifies the relationship between caffeine exposure and kidney outcomes.

Main Methods:

• Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial.
• Included neonates born <28 weeks' gestation with kidney outcome data at 22-26 months corrected age.
• Analyzed kidney outcomes including reduced estimated glomerular filtration rate (eGFR), albuminuria, and elevated blood pressure (BP), stratified by BPD status.

Main Results:

• In the overall cohort, caffeine discontinuation timing was not associated with abnormal kidney function at 2 years.
• In neonates without BPD, each additional week of caffeine was associated with a 21% decreased odds of reduced eGFR.
• In neonates with BPD, each additional week of caffeine was associated with a 15% increased odds of elevated BP.

Conclusions:

• Neonatal caffeine exposure duration is linked to differential kidney outcomes at 22-26 months, influenced by BPD status.
• Later caffeine discontinuation in ELGANs may increase the risk of reduced eGFR in those without BPD and hypertension in those with BPD.
• Further research is needed to elucidate the long-term renal effects of caffeine in premature infants.