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Am J Perinatol 2018; 35(01): 001-009
DOI: 10.1055/s-0037-1604260
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management

A. L. Kent   *
1   Department of Neonatology, Canberra and Australian National University, Canberra, Australia
,
J. R. Charlton   *
2   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
R. Guillet
3   Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, New York
,
K. M. Gist
4   Department of Pediatrics, University of Colorado, Aurora, Colorado
,
M. Hanna
5   Department of Pediatrics, University of Kentucky, Lexington, Kentucky
,
A. El Samra
6   Department of Pediatrics and Neonatology, Franciscan St. Elizabeth Health, East Lafayette, Indiana
,
J. Fletcher
7   Department of Paediatrics, Canberra and Australian National University, Canberra, Australia
,
D. T. Selewski
8   Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
,
C. Mammen
9   Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
› Author Affiliations
Further Information

Publication History

17 April 2017

08 June 2017

Publication Date:
14 July 2017 (online)

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Abstract

Background Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI.

Methods A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices.

Results Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up.

Conclusion Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.

Keywords

neonatologist - pediatric nephrologist - neonatal acute kidney injury - survey

Authors' Contributions

Kent-contributed to the design of the project, analyzed data, wrote first draft of the manuscript, and critically reviewed/edited and approved the final version.


Charlton-contributed to the design of the project, contributed to the first draft of the manuscript, and critically reviewed/edited and approved the final version.


Guillet-contributed to the design of the project and critically reviewed/edited and approved the final version.


Gist-contributed to the design of the project and critically reviewed/edited and approved the final version.


Hanna-contributed to the design of the project and critically reviewed/edited and approved the final version.


El Samra-critically reviewed/edited and approved the final version.


Fletcher-critically reviewed/edited and approved the final version.


Selewski-contributed to the design of the project, contributed to early drafts of manuscript, and critically reviewed/edited and approved the final version.


Mammen-conceived the original idea, contributed to the design of the project, contributed to early drafts of manuscript, and critically reviewed/edited and approved the final version.


* Both the authors contributed equally to the article.


Supplementary Material

 

  • References

  • 1 Blinder JJ, Goldstein SL, Lee VV. , et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012; 143 (02) 368-374
    CrossrefPubMedGoogle Scholar
  • 2 Gadepalli SK, Selewski DT, Drongowski RA, Mychaliska GB. Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem. J Pediatr Surg 2011; 46 (04) 630-635
    CrossrefPubMedGoogle Scholar
  • 3 Kaur S, Jain S, Saha A. , et al. Evaluation of glomerular and tubular renal function in neonates with birth asphyxia. Ann Trop Paediatr 2011; 31 (02) 129-134
    CrossrefPubMedGoogle Scholar
  • 4 Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res 2011; 69 (04) 354-358
    CrossrefPubMedGoogle Scholar
  • 5 Sarkar S, Askenazi DJ, Jordan BK. , et al. Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia. Pediatr Res 2014; 75 (03) 431-435
    CrossrefPubMedGoogle Scholar
  • 6 Selewski DT, Jordan BK, Askenazi DJ, Dechert RE, Sarkar S. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr 2013; 162 (04) 725-729.e1
    CrossrefPubMedGoogle Scholar
  • 7 Selewski DT, Cornell TT, Heung M. , et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 2014; 40 (10) 1481-1488
    CrossrefPubMedGoogle Scholar
  • 8 Sutherland SM, Ji J, Sheikhi FH. , et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol 2013; 8 (10) 1661-1669
    CrossrefPubMedGoogle Scholar
  • 9 Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007; 71 (10) 1028-1035
    CrossrefPubMedGoogle Scholar
  • 10 Alkandari O, Eddington KA, Hyder A. , et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care 2011; 15 (03) R146
    CrossrefPubMedGoogle Scholar
  • 11 Menon S, Kirkendall ES, Nguyen H, Goldstein SL. Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months. J Pediatr 2014; 165 (03) 522-527.e2
    PubMedGoogle Scholar
  • 12 Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3–5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int 2006; 69 (01) 184-189
    CrossrefPubMedGoogle Scholar
  • 13 Abitbol CL, Bauer CR, Montané B, Chandar J, Duara S, Zilleruelo G. Long-term follow-up of extremely low birth weight infants with neonatal renal failure. Pediatr Nephrol 2003; 18 (09) 887-893
    CrossrefPubMedGoogle Scholar
  • 14 Bruel A, Rozé JC, Quere MP. , et al. Renal outcome in children born preterm with neonatal acute renal failure: IRENEO-a prospective controlled study. Pediatr Nephrol 2016; 31 (12) 2365-2373
    CrossrefPubMedGoogle Scholar
  • 15 Zwiers AJ, IJsselstijn H, van Rosmalen J. , et al. CKD and hypertension during long-term follow-up in children and adolescents previously treated with extracorporeal membrane oxygenation. Clin J Am Soc Nephrol 2014; 9 (12) 2070-2078
    CrossrefPubMedGoogle Scholar
  • 16 Cooper DS, Claes D, Goldstein SL. , et al. Follow-up renal assessment of injury long-term after acute kidney injury (FRAIL-AKI). Clin J Am Soc Nephrol 2016; 11 (01) 21-29
    CrossrefPubMedGoogle Scholar
  • 17 Mammen C, Al Abbas A, Skippen P. , et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 2012; 59 (04) 523-530
    CrossrefPubMedGoogle Scholar
  • 18 Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012; 81 (05) 442-448
    CrossrefPubMedGoogle Scholar
  • 19 Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012; 24 (02) 191-196
    CrossrefPubMedGoogle Scholar
  • 20 Jetton JG, Guillet R, Askenazi DJ. , et al; Neonatal Kidney Collaborative. Assessment of worldwide acute kidney injury epidemiology in neonates (AWAKEN): design of a retrospective cohort study. Front Pediatr 2016; 4: 68
    PubMedGoogle Scholar
  • 21 Fortenberry JD, Paden ML, Goldstein SL. Acute kidney injury in children: an update on diagnosis and treatment. Pediatr Clin North Am 2013; 60 (03) 669-688
    CrossrefPubMedGoogle Scholar
  • 22 Misurac JM, Knoderer CA, Leiser JD, Nailescu C, Wilson AC, Andreoli SP. Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. J Pediatr 2013; 162 (06) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 23 Goldstein SL, Kirkendall E, Nguyen H. , et al. Electronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics 2013; 132 (03) e756-e767
    CrossrefPubMedGoogle Scholar
  • 24 Zappitelli M, Moffett BS, Hyder A, Goldstein SL. Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: a retrospective cohort study. Nephrol Dial Transplant 2011; 26 (01) 144-150
    CrossrefPubMedGoogle Scholar
  • 25 Rhone ET, Carmody JB, Swanson JR, Charlton JR. Nephrotoxic medication exposure in very low birth weight infants. J Matern Fetal Neonatal Med 2014; 27 (14) 1485-1490
    CrossrefPubMedGoogle Scholar
  • 26 Perazella MA, Wilson FP. Acute kidney injury: preventing acute kidney injury through nephrotoxin management. Nat Rev Nephrol 2016; 12 (09) 511-512
    CrossrefPubMedGoogle Scholar
  • 27 Akima S, Kent A, Reynolds GJ, Gallagher M, Falk MC. Indomethacin and renal impairment in neonates. Pediatr Nephrol 2004; 19 (05) 490-493
    CrossrefPubMedGoogle Scholar
  • 28 Goldstein SL, Mottes T, Simpson K. , et al. A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury. Kidney Int 2016; 90 (01) 212-221
    CrossrefPubMedGoogle Scholar
  • 29 Akbar SR, Iqbal HI, Ahmed U. The need to emphasize nephrology knowledge in residents-in-training. N Am J Med Sci 2015; 7 (11) 524-528
    CrossrefPubMedGoogle Scholar
  • 30 Zwiers AJ, de Wildt SN, Hop WC. , et al. Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation: a 14-year cohort study. Crit Care 2013; 17 (04) R151
    CrossrefPubMedGoogle Scholar
  • 31 Costa e Silva VT, Liaño F, Muriel A, Díez R, de Castro I, Yu L. Nephrology referral and outcomes in critically ill acute kidney injury patients. PLoS One 2013; 8 (08) e70482
    CrossrefPubMedGoogle Scholar
  • 32 Meier P, Bonfils RM, Vogt B, Burnand B, Burnier M. Referral patterns and outcomes in noncritically ill patients with hospital-acquired acute kidney injury. Clin J Am Soc Nephrol 2011; 6 (09) 2215-2225
    CrossrefPubMedGoogle Scholar
  • 33 Carmody ZJB, Swanson JR, Rhone ET, Charlton JR. Recognition and reporting of AKI in very low birth weight infants. Clin J Am Soc Nephrol 2014; 9 (12) 2036-2043
    CrossrefPubMedGoogle Scholar
  • 34 Sutherland SM, Alexander SR. Continuous renal replacement therapy in children. Pediatr Nephrol 2012; 27 (11) 2007-2016
    CrossrefPubMedGoogle Scholar
  • 35 Warady BA, Bunchman T. Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol 2000; 15 (1–2): 11-13
    CrossrefPubMedGoogle Scholar
  • 36 Ronco C, Garzotto F, Brendolan A. , et al. Continuous renal replacement therapy in neonates and small infants: development and first-in-human use of a miniaturised machine (CARPEDIEM). Lancet 2014; 383 (9931): 1807-1813
    CrossrefPubMedGoogle Scholar
  • 37 Coulthard MG, Crosier J, Griffiths C. , et al. Haemodialysing babies weighing 2009 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis. Pediatr Nephrol 2014; 29 (10) 1873-1881
    CrossrefPubMedGoogle Scholar
  • 38 Goldstein SL, Currier H, Graf Cd, Cosio CC, Brewer ED, Sachdeva R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001; 107 (06) 1309-1312
    CrossrefPubMedGoogle Scholar
  • 39 Hayes LW, Oster RA, Tofil NM, Tolwani AJ. Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care 2009; 24 (03) 394-400
    CrossrefPubMedGoogle Scholar
  • 40 Selewski DT, Cornell TT, Lombel RM. , et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011; 37 (07) 1166-1173
    CrossrefPubMedGoogle Scholar
  • 41 Sutherland SM, Zappitelli M, Alexander SR. , et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010; 55 (02) 316-325
    CrossrefPubMedGoogle Scholar
  • 42 Foland JA, Fortenberry JD, Warshaw BL. , et al. Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med 2004; 32 (08) 1771-1776
    CrossrefPubMedGoogle Scholar
  • 43 Gillespie RS, Seidel K, Symons JM. Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol 2004; 19 (12) 1394-1399
    CrossrefPubMedGoogle Scholar
  • 44 Ostermann M, Straaten HM, Forni LG. Fluid overload and acute kidney injury: cause or consequence?. Crit Care 2015; 19: 443
    CrossrefPubMedGoogle Scholar
  • 45 Hassinger AB, Wald EL, Goodman DM. Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med 2014; 15 (02) 131-138
    PubMedGoogle Scholar
  • 46 Chaturvedi S, Ng KH, Mammen C. The path to chronic kidney disease following acute kidney injury: a neonatal perspective. Pediatr Nephrol 2017; 32 (02) 227-241
    CrossrefPubMedGoogle Scholar
  • 47 Bruel A, Rozé JC, Flamant C, Simeoni U, Roussey-Kesler G, Allain-Launay E. Critical serum creatinine values in very preterm newborns. PLoS One 2013; 8 (12) e84892
    CrossrefPubMedGoogle Scholar