Objective: This study aimed to evaluate the association between acute kidney injury (AKI) and bronchopulmonary dysplasia (BPD) in infants born <32 weeks of gestational age (GA).
Study design: Present study is a secondary analysis of premature infants born at <32 weeks of GA in the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) retrospective cohort (n = 546). We stratified by gestational age and used logistic regression to determine association between AKI and moderate or severe BPD/mortality.
Results: Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47-2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07-8.61; p < 0.001).
Conclusion: Neonates born between 29 and 32 weeks who develop AKI had a higher likelihood of moderate or severe BPD/death than those without AKI. Further studies are needed to validate our findings and evaluate mechanisms of multiorgan injury.
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Conflict of interest statement
All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. This study was supported by the NIH U01NS077953 (L.B., R.G., L.L., and D.A.) and T32DK007662 (MS). For full disclosure, we provide the additional list of authors' other commitments and funding sources that are not directly related to this study. D.A. reports serving on the speaker board for Baxter and for the Acute Kidney Injury Foundation; he also reported receiving grant funding for studies not related to this work, grant R01 DK103608 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, and grant R01 FD005092 from the National Institutes of Health/US Food and Drug Administration. S.G. reports receiving grant funding for studies not related to this work, grant R01 DK103608 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases. No other disclosures were reported.
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Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants.Pediatr Nephrol. 2015 Sep;30(9):1511-8. doi: 10.1007/s00467-015-3087-5. Epub 2015 Mar 26. Pediatr Nephrol. 2015. PMID: 25808019 Free PMC article.
Association Between Early Caffeine Citrate Administration and Risk of Acute Kidney Injury in Preterm Neonates: Results From the AWAKEN Study.JAMA Pediatr. 2018 Jun 4;172(6):e180322. doi: 10.1001/jamapediatrics.2018.0322. Epub 2018 Jun 4. JAMA Pediatr. 2018. PMID: 29610830 Free PMC article. Clinical Trial.
Association of Noninvasive Ventilation Strategies With Mortality and Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review and Meta-analysis.JAMA. 2016 Aug 9;316(6):611-24. doi: 10.1001/jama.2016.10708. JAMA. 2016. PMID: 27532916 Review.
Inhaled versus systemic corticosteroids for preventing bronchopulmonary dysplasia in ventilated very low birth weight preterm neonates.Cochrane Database Syst Rev. 2017 Oct 17;10(10):CD002058. doi: 10.1002/14651858.CD002058.pub3. Cochrane Database Syst Rev. 2017. PMID: 29041034 Free PMC article. Review.
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