title: Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants.
abstract: BACKGROUND
  Acute kidney injury (AKI) impairs electrolyte balance, alters fluid homeostasis and decreases toxin excretion. More recent data suggest it also affects the physiology of distant organs.
  
  
  METHODS
  We performed a prospective cohort study which invloved 122 premature infants [birth weight (BW) ≤1200 g and/or gestational age (GA) <31 weeks] to determine relationships between AKI and bronchopulmonary dysplasia (BPD)/mortality. Days until oxygen discontinuation was compared between those with and without AKI in survivors who received oxygen for ≥24 h.
  
  
  RESULTS
  Acute kidney disease, defined by a rise in serum creatinine (SCr) of ≥0.3 mg/dl or an increase in SCr of ≥150%, occurred in 36/122 (30%) of the premature infants. Those with AKI had a 70% higher risk of oxygen requirement or of dying at 28 days of life [relative risk (RR) 1.71, 95% confidence interval (CI) 1.22-2.39; p < 0.002]. This association remained after controlling for GA, pre-eclampsia, 5 min Apgar score and percentage maximum weight change (max % weight Δ) in the first 4 days (RR 1.45, 95% CI 1.07-1.97); p < 0.02). Similar findings were noted for receipt of mechanical ventilation/death by day 28 (adjusted RR 1.53, 95% CI 1.05-2.22; p < 0.03). Those without AKI were 2.5-fold more likely to come off oxygen [hazard ratio (HR) 1.3-5; p < 0.02) than those with AKI, even when controlling for GA, pre-eclampsia, 5 min Apgar and max % weight Δ (multivariate HR 2.0, 95% CI 0.9-4.0; p < 0.06).
  
  
  CONCLUSIONS
  In premature infants, AKI is associated with BPD/mortality. As AKI could lead to altered lung physiology, interventions to ameliorate AKI could improve long-term BPD.
authors: Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave S, Lowder 516, Birmingham, AL, 35223, USA, daskenazi@peds.uab.edu.
authors: David
authors: D
authors: Askenazi
authors: Neha R
authors: NR
authors: Patil
authors: Namasivayam
authors: N
authors: Ambalavanan
authors: Jessica
authors: J
authors: Balena-Borneman
authors: David J
authors: DJ
authors: Lozano
authors: Manimaran
authors: M
authors: Ramani
authors: Monica
authors: M
authors: Collins
authors: Russell L
authors: RL
authors: Griffin
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D001034:Apgar Score; D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D008297:Male; D017063:Outcome Assessment, Health Care; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D065667:Renal Elimination; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000503:physiopathology
chemical_list: D003404:Creatinine