Urine Output Monitoring for the Diagnosis of Early-Onset Acute Kidney Injury in Very Preterm Infants.
acute kidney injury
early diagnosis
infant
mortality
neonatal KDIGO
preterm
tubular immaturity
urine output
very preterm
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
22
11
2021
accepted:
16
05
2022
pubmed:
29
6
2022
medline:
12
7
2022
entrez:
28
6
2022
Statut:
ppublish
Résumé
The current threshold used for oliguria in the definition of neonatal AKI has been empirically defined as 1 ml/kg per hour. Urine output criteria are generally poorly documented, resulting in uncertainty in the most accurate threshold to identify AKI in very preterm infants with known tubular immaturity. We conducted a bicentric study including 473 very preterm infants (24 Early-onset AKI was developed by 101 of 473 (21%) very preterm infants. AKI was diagnosed on the basis of urine output criteria alone (no rise in creatinine) for 27 of 101 (27%) participants. Early-onset AKI was associated with higher risk of death before discharge (adjusted odds ratio, 3.9; 95% confidence interval, 1.9 to 7.8), and the AKI neonatal KDIGO score showed good discriminative performance for neonatal mortality, with an area under the receiver operating characteristic (ROC) curve of 0.68 (95% confidence interval, 0.61 to 0.75). Modified AKI definitions that included higher urine output thresholds showed significantly improved discriminative performance, with areas under the ROC curve of 0.73 (95% confidence interval, 0.66 to 0.80) for the 1.5-ml/kg per hour threshold and 0.75 (95% confidence interval, 0.68 to 0.81) for the 2-ml/kg per hour threshold. Early-onset AKI was diagnosed on the basis of urine output exclusively for a quarter of the cases. Furthermore, modified AKI definitions that included higher urine output improved the discriminative performance for predicting mortality.
Sections du résumé
BACKGROUND AND OBJECTIVES
The current threshold used for oliguria in the definition of neonatal AKI has been empirically defined as 1 ml/kg per hour. Urine output criteria are generally poorly documented, resulting in uncertainty in the most accurate threshold to identify AKI in very preterm infants with known tubular immaturity.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We conducted a bicentric study including 473 very preterm infants (24
RESULTS
Early-onset AKI was developed by 101 of 473 (21%) very preterm infants. AKI was diagnosed on the basis of urine output criteria alone (no rise in creatinine) for 27 of 101 (27%) participants. Early-onset AKI was associated with higher risk of death before discharge (adjusted odds ratio, 3.9; 95% confidence interval, 1.9 to 7.8), and the AKI neonatal KDIGO score showed good discriminative performance for neonatal mortality, with an area under the receiver operating characteristic (ROC) curve of 0.68 (95% confidence interval, 0.61 to 0.75). Modified AKI definitions that included higher urine output thresholds showed significantly improved discriminative performance, with areas under the ROC curve of 0.73 (95% confidence interval, 0.66 to 0.80) for the 1.5-ml/kg per hour threshold and 0.75 (95% confidence interval, 0.68 to 0.81) for the 2-ml/kg per hour threshold.
CONCLUSIONS
Early-onset AKI was diagnosed on the basis of urine output exclusively for a quarter of the cases. Furthermore, modified AKI definitions that included higher urine output improved the discriminative performance for predicting mortality.
Identifiants
pubmed: 35764392
pii: 01277230-202207000-00006
doi: 10.2215/CJN.15231121
pmc: PMC9269638
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
949-956Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 by the American Society of Nephrology.
Références
Pediatr Nephrol. 2020 Sep;35(9):1737-1748
pubmed: 32488672
Nephrol Dial Transplant. 2013 Apr;28(4):901-9
pubmed: 23348885
Curr Opin Pediatr. 2018 Apr;30(2):228-235
pubmed: 29432217
JAMA Pediatr. 2015 Mar;169(3):230-8
pubmed: 25621457
Curr Opin Pediatr. 2018 Apr;30(2):236-240
pubmed: 29389682
J Pediatr Intensive Care. 2016 Jun;5(2):69-78
pubmed: 31110888
Am J Hypertens. 1988 Oct;1(4 Pt 1):335-47
pubmed: 3063284
Pediatr Res. 2017 Oct;82(4):569-573
pubmed: 28604760
Arch Dis Child Fetal Neonatal Ed. 2004 Mar;89(2):F180-1
pubmed: 14977908
Pediatr Nephrol. 2017 Feb;32(2):227-241
pubmed: 26809804
Lancet Glob Health. 2019 Jan;7(1):e2-e3
pubmed: 30389450
Pediatrics. 2015 Aug;136(2):e463-73
pubmed: 26169430
Pediatrics. 2013 Jun;131(6):1168-79
pubmed: 23669525
World J Nephrol. 2017 Sep 6;6(5):229-235
pubmed: 28948160
N Engl J Med. 2017 Jan 5;376(1):11-20
pubmed: 27959707
Lancet Child Adolesc Health. 2017 Nov;1(3):184-194
pubmed: 29732396
Clin J Am Soc Nephrol. 2019 Feb 7;14(2):184-195
pubmed: 31738181
Lancet Glob Health. 2019 Jan;7(1):e37-e46
pubmed: 30389451
J Pediatr. 2010 Nov;157(5):733-9.e1
pubmed: 20955846
Clin J Am Soc Nephrol. 2014 Dec 5;9(12):2036-43
pubmed: 25280497
Intensive Care Med. 2015 Aug;41(8):1411-23
pubmed: 26162677
Semin Fetal Neonatal Med. 2017 Apr;22(2):90-97
pubmed: 28034548
Cochrane Database Syst Rev. 2020 Dec 25;12:CD004454
pubmed: 33368142