Incidence, Risk Factors, and Outcomes Associated With Recurrent Neonatal Acute Kidney Injury in the AWAKEN Study

Area of Science:

• Neonatal intensive care
• Pediatric nephrology
• Critical care medicine

Background:

• Recurrent acute kidney injury (rAKI) in neonates is poorly understood, lacking data on its incidence and outcomes.
• Identifying risk factors and clinical consequences of rAKI is crucial for improving neonatal care.

Purpose of the Study:

• To determine the incidence, risk factors, and clinical outcomes of recurrent acute kidney injury (rAKI) in critically ill neonates.
• To compare outcomes of neonates with no AKI, single AKI (sAKI), and rAKI.

Main Methods:

• Secondary analysis of a multicenter, international retrospective study including neonates under 14 days old.
• Defined rAKI using neonatal Kidney Disease: Improving Global Outcomes criteria, requiring return to baseline creatinine.
• Compared length of stay (LOS) and mortality among neonates with no AKI, sAKI, and rAKI.

Main Results:

• Of 605 neonates with AKI, 133 (22.0%) experienced rAKI.
• Risk factors for rAKI included younger gestational age, lower birthweight, and higher initial AKI stage.
• Neonates with rAKI had significantly longer median LOS (60 days) compared to sAKI (18 days) and no AKI (17 days).
• rAKI was independently associated with a lower hazard of discharge but not increased mortality compared to sAKI.

Conclusions:

• Neonatal rAKI is independently associated with prolonged hospital stays.
• rAKI represents a significant clinical distinction in neonates, necessitating further research and vigilant monitoring post-initial AKI.
• The findings underscore the importance of recognizing and managing rAKI to potentially improve neonatal outcomes.