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Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study

Open access
Jetton, Jennifer G, Boohaker, Louis J, Sethi, Sidharth K, Wazir, Sanjay, Rohatgi, Smriti, Soranno, Danielle E, Chishti, Aftab S, Woroniecki, Robert, Mammen, Cherry, Swanson, Jonathan R, Sridhar, Shanthy, Wong, Craig S, Kupferman, Juan C, Griffin, Russell L, Askenazi, David J, Selewski, David T, Sarkar, Subrata, Kent, Alison, Fletcher, Jeffery, Abitbol, Carolyn L, DeFreitas, Marissa, Duara, Shahnaz, Charlton, Jennifer R, Guillet, Ronnie, D'Angio, Carl, Mian, Ayesa, Rademacher, Erin, Mhanna, Maroun J, Raina, Rupesh, Kumar, Deepak, Ambalavanan, Namasivayam, Arikan, Ayse Akcan, Rhee, Christopher J, Goldstein, Stuart L, Nathan, Amy T, Bhutada, Alok, Rastogi, Shantanu, Bonachea, Elizabeth, Ingraham, Susan, Mahan, John, Nada, Arwa, Brophy, Patrick D, Colaizy, Tarah T, Klein, Jonathan M, Cole, F Sessions, Davis, T Keefe, Dower, Joshua, Milner, Lawrence, Smith, Alexandra, Fuloria, Mamta, Reidy, Kimberly, Kaskel, Frederick J, Gien, Jason, Gist, Katja M, Hanna, Mina H, Hingorani, Sangeeta, Starr, Michelle, Joseph, Catherine, DuPont, Tara, Ohls, Robin, Staples, Amy, Khokhar, Surender, Perazzo, Sofia, Ray, Patricio E, Revenis, Mary, Synnes, Anne, Wintermark, Pia·2017·The Lancet Child & Adolescent Health
DOI 10.1016/s2352-4642(17)30069-x
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Abstract

Background Single-center studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, inferences regarding the association between AKI, mortality, and hospital length of stay are limited due to the small sample size of those studies. In order to determine whether neonatal AKI is independently associated with increased mortality and longer hospital stay, we analyzed the Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) database. Methods All neonates admitted to 24 participating neonatal intensive care units from four countries (Australia, Canada, India, United States) between January 1 and March 31, 2014, were screened. Of 4273 neonates screened, 2022 (47·3%) met study criteria. Exclusion criteria included: no intravenous fluids ≥48 hours, admission ≥14 days of life, congenital heart disease requiring surgical repair at <7 days of life, lethal chromosomal anomaly, death within 48 hours, inability to determine AKI status or severe congenital kidney abnormalities. AKI was defined using a standardized definition —i.e., serum creatinine rise of ≥0.3 mg/dL (26.5 mcmol/L) or ≥50% from previous lowest value, and/or if urine output was <1 mL/kg/h on postnatal days 2 to 7. Findings Incidence of AKI was 605/2022 (29·9%). Rates varied by gestational age groups (i.e., ≥22 to <29 weeks =47·9%; ≥29 to <36 weeks =18·3%; and ≥36 weeks =36·7%). Even after adjusting for multiple potential confounding factors, infants with AKI had higher mortality compared to those without AKI [(59/605 (9·7%) vs. 20/1417 (1·4%); p< 0.001; adjusted OR=4·6 (95% CI=2·5–8·3); p=<0·0001], and longer hospital stay [adjusted parameter estimate 8·8 days (95% CI=6·1–11·5); p<0·0001]. Interpretation Neonatal AKI is a common and independent risk factor for mortality and longer hospital stay. These data suggest that neonates may be impacted by AKI in a manner similar to pediatric and adult patients. Funding US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children’s, University of New Mexico.

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Authors
Jetton, J. G., Boohaker, L. J., Sethi, S. K., Wazir, S., Rohatgi, S., Soranno, D. E., Chishti, A. S., Woroniecki, R., Mammen, C., Swanson, J. R., Sridhar, S., Wong, C. S., Kupferman, J. C., Griffin, R. L., Askenazi, D. J., Selewski, D. T., Sarkar, S., Kent, A., Fletcher, J., Abitbol, C. L., DeFreitas, M., Duara, S., Charlton, J. R., Guillet, R., D'Angio, C., Mian, A., Rademacher, E., Mhanna, M. J., Raina, R., Kumar, D., Ambalavanan, N., Arikan, A. A., Rhee, C. J., Goldstein, S. L., Nathan, A. T., Bhutada, A., Rastogi, S., Bonachea, E., Ingraham, S., Mahan, J., Nada, A., Brophy, P. D., Colaizy, T. T., Klein, J. M., Cole, F. S., Davis, T. K., Dower, J., Milner, L., Smith, A., Fuloria, M., Reidy, K., Kaskel, F. J., Gien, J., Gist, K. M., Hanna, M. H., Hingorani, S., Starr, M., Joseph, C., DuPont, T., Ohls, R., Staples, A., Khokhar, S., Perazzo, S., Ray, P. E., Revenis, M., Synnes, A., & Wintermark, P.
Venue
The Lancet Child & Adolescent Health
Publisher
Elsevier BV
Published
2017-11
Volume
1
Issue
3
Pages
184-194
ISSN
2352-4642 (ISSN-L)
DOI
10.1016/s2352-4642(17)30069-x
OpenAlex
W2752404888
Cited by
734
References
22
FWCI
27.91
Type
journal article
Language
en
Open access
green

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CoChat. (2026). Citation check: Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. https://app.cochat.ai/papers/10.1016/s2352-4642(17)30069-x
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Jetton, J. G., Boohaker, L. J., Sethi, S. K., Wazir, S., Rohatgi, S., Soranno, D. E., Chishti, A. S., Woroniecki, R., Mammen, C., Swanson, J. R., Sridhar, S., Wong, C. S., Kupferman, J. C., Griffin, R. L., Askenazi, D. J., Selewski, D. T., Sarkar, S., Kent, A., Fletcher, J., . . . Wintermark, P. (2017). Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. The Lancet Child & Adolescent Health. https://doi.org/10.1016/s2352-4642(17)30069-x

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