Factors associated with acute kidney injury in neonates admitted in a tertiary-care setting of a developing country: A cross-sectional study.

Abstract

Objective: To assess the prevalence, risk factors and outcome of acute kidney injury (AKI) in neonates admitted in a neonatal intensive care unit (NICU) of developing country. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit at Sheikh Saeed Memorial Campus (SSMC) of Indus Hospital and Health Network (IHHN), Karachi, Pakistan. Period: April 2022 to September 2022. Material & Methods: Four hundred and seventy-one newborns hospitalized to the NICU were analyzed. Demographic details along with maternal and neonatal history, vitals, and clinical signs of newborns were noted. All at-risk newborns had their urine output assessed. Serum creatinine levels were assessed to classify AKI into stages using modified KDIGO criteria. Results: Out of 471 participants, 256 (54.4%) neonates were male. The prevalence of AKI was noted in 42 (8.9%) neonates. Based on the modified KDIGO stages, 26 (61.9%), 7 (16.6%), 7 (16.6%), and 2 (4.7%) neonates met the requirements for AKI stages 0, 1, 2, and 3, respectively. In comparison to newborns with normal renal function, newborns with AKI had significantly higher serum creatinine levels (p<0.001), lower urine output (p=<0.001), and lower creatinine clearance rates (p=0.001). Multivariate analysis showed that sepsis enhanced the risk of acquiring AKI (OR: 60.50, 95% CI: 26.03-169.88). Neonates in distress, and on ventilator had a higher risk of having AKI (OR: 13.88, 95% CI: 1.26-152.91) and (OR: 20.77, 95% CI: 1.1-390.49) respectively. Conclusion: The prevalence of AKI among neonates admitted in NICU was 8.9%. Fetal distress, sepsis and mechanical ventilation were significantly associated with AKI.