Improving Recognition of Acute Kidney Injury in Preterm Infants Admitted to the Neonatal Intensive Care Unit: An Abstract from Akron Children’s Hospital Resident and Fellow Academic Day

Acute kidney injury (AKI) is common in the neonatal intensive care unit (NICU), occurring in up to 40% of infants with a birth weight <1500 g. The modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria are accepted. However, AKI remains underreported in the NICU due to challenges in obtaining accurate urine output measurements and interpretation of serum creatinine changes from baseline. The objective of this study is to determine the incidence of AKI in infants <32 weeks gestation based on the modified KDIGO criteria and identify the percentage of time those meeting criteria received an AKI diagnosis by the medical team. This is a retrospective review from January 1, 2021, to December 31, 2023, of neonates born <32 weeks gestation, admitted to Akron Children’s NICU, who had ≥3 serum creatinine values measured during NICU hospitalization and survived > 72 hours. Deidentified data was collected from the electronic medical record. A diagnosis of AKI was determined for each patient based on creatinine values according to the modified KDIGO criteria. Fisher’s exact test and simple logistic regression were performed. Of 687 infants who had <32 weeks gestation who were admitted during the specified time period, 489 (71%) had ≥3 creatinine values in the EMR. Using the modified KDIGO criteria, 64 infants (13.1%) met criteria for AKI. Of those patients who met the criteria, only 17 (26.6%) had a diagnosis documented in the EMR. There was an inverse association between gestational age and meeting KDIGO criteria for AKI, p <0.0001. Additionally, the younger gestational age grouping of 22-25 weeks gestation was more likely to have AKI documented by the medical team than the older gestational age group of 26-29 weeks (33% vs 7%, P=0.05). Receipt of an AKI diagnosis was associated with a higher creatinine value with an odds ratio of 32.1 (95% CI: 6.3, 269.4; P <0.001), indicating that for every 0.1 rise in creatinine value, the odds of receiving an AKI diagnosis in the EMR increased by 3.2. Similarly, infants who had AKI diagnosed by the medical team were more likely to have a higher stage of AKI than those with no diagnosis in the EMR (Stage 3: 12% vs 9%, Stage 2: 59% vs 26%, Stage 1: 29% vs 66%; p<0.02). Neonates born at <32 weeks gestation with AKI based on modified KDIGO criteria were identified only 26% of the time. Those with younger gestational age, higher single creatinine values, and higher stage of AKI were more likely to have their AKI diagnosed by the medical team. This data can assist in the development of interventions to enhance recognition of AKI in the NICU, which could improve long-term kidney outcomes.