Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately

Heidi J. Murphy; Jason Gien; Rashmi Sahay; Eileen King; David T. Selewski; Brian C. Bridges; David S. Cooper; Geoffrey M. Fleming; Matthew L. Paden; Michael Zappitelli; Katja M. Gist; Rajit K. Basu; Jennifer G. Jetton; David Askenazi

doi:10.1159/000512538

Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately

Heidi J. Murphy^*, Jason Gien, Rashmi Sahay, Eileen King, David T. Selewski, Brian C. Bridges, David S. Cooper, Geoffrey M. Fleming, Matthew L. Paden, Michael Zappitelli, Katja M. Gist, Rajit K. Basu, Jennifer G. Jetton, David Askenazi

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

Introduction: We aimed to characterize acute kidney injury (AKI), fluid overload (FO), and renal replacement therapy (RRT) utilization by diagnostic categories and examine associations between these complications and mortality by category. Methods: To test our hypotheses, we conducted a retrospective multicenter, cohort study including 446 neonates (categories: 209 with cardiac disease, 114 with congenital diaphragmatic hernia [CDH], 123 with respiratory disease) requiring extracorporeal membrane oxygenation (ECMO) between January 1, 2007, and December 31, 2011. Results: AKI, FO, and RRT each varied by diagnostic category. AKI and RRT receipt were most common in those neonates with cardiac disease. Subjects with CDH had highest peak %FO (51% vs. 28% cardiac vs. 32% respiratory; p < 0.01). Hospital survival was 55% and varied by diagnostic category (45% cardiac vs. 48% CDH vs. 79% respiratory; p < 0.001). A significant interaction suggested risk of mortality differed by diagnostic category in the presence or absence of AKI. In its absence, diagnosis of CDH (vs. respiratory disease) (OR 3.04, 95% CL 1.14-8.11) independently predicted mortality. In all categories, peak %FO (OR 1.20, 95% CL 1.11-1.30) and RRT receipt (OR 2.12, 95% CL 1.20-3.73) were independently associated with mortality. Discussion/Conclusions: Physiologically distinct ECMO diagnoses warrant individualized treatment strategies given variable incidence and effects of AKI, FO, and RRT by category on mortality.

Original language	English (US)
Pages (from-to)	808-817
Number of pages	10
Journal	Blood Purification
Volume	50
Issue number	6
DOIs	https://doi.org/10.1159/000512538
State	Published - Sep 1 2021

Funding

For full disclosure, we provide here an additional list of other author’s commitments and funding sources that are not directly related to this study. David J. Askenazi serves on the speaker board for Baxter (Baxter, USA), and the Acute Kidney Injury Foundation (Cincinnati, OH, USA). He is consultant for Baxter, CHF solutions, and Medtronic. He also receives grant funding from studies not related to this project from Baxter, CHF solutions, and National Institutes of Health NIH-FDA (R01 Fd005092) and the Pediatric and Infant Center for Acute Nephrology (PICAN). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB) and is funded by Children’s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). The remaining authors declare no conflicts of interest. Funding sources for this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. RedCap at Vanderbilt is supported through UL1 TR000445 from NACTS/NIH.

Keywords

Continuous renal replacement therapy
Extracorporeal membrane oxygenation
Extracorporeal therapy
Renal dysfunction
Renal failure
Renal injury

ASJC Scopus subject areas

Nephrology
Hematology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1159/000512538

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Murphy, H. J., Gien, J., Sahay, R., King, E., Selewski, D. T., Bridges, B. C., Cooper, D. S., Fleming, G. M., Paden, M. L., Zappitelli, M., Gist, K. M., Basu, R. K., Jetton, J. G., & Askenazi, D. (2021). Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately. Blood Purification, 50(6), 808-817. https://doi.org/10.1159/000512538

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title = "Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately",

abstract = "Introduction: We aimed to characterize acute kidney injury (AKI), fluid overload (FO), and renal replacement therapy (RRT) utilization by diagnostic categories and examine associations between these complications and mortality by category. Methods: To test our hypotheses, we conducted a retrospective multicenter, cohort study including 446 neonates (categories: 209 with cardiac disease, 114 with congenital diaphragmatic hernia [CDH], 123 with respiratory disease) requiring extracorporeal membrane oxygenation (ECMO) between January 1, 2007, and December 31, 2011. Results: AKI, FO, and RRT each varied by diagnostic category. AKI and RRT receipt were most common in those neonates with cardiac disease. Subjects with CDH had highest peak %FO (51% vs. 28% cardiac vs. 32% respiratory; p < 0.01). Hospital survival was 55% and varied by diagnostic category (45% cardiac vs. 48% CDH vs. 79% respiratory; p < 0.001). A significant interaction suggested risk of mortality differed by diagnostic category in the presence or absence of AKI. In its absence, diagnosis of CDH (vs. respiratory disease) (OR 3.04, 95% CL 1.14-8.11) independently predicted mortality. In all categories, peak %FO (OR 1.20, 95% CL 1.11-1.30) and RRT receipt (OR 2.12, 95% CL 1.20-3.73) were independently associated with mortality. Discussion/Conclusions: Physiologically distinct ECMO diagnoses warrant individualized treatment strategies given variable incidence and effects of AKI, FO, and RRT by category on mortality.",

keywords = "Continuous renal replacement therapy, Extracorporeal membrane oxygenation, Extracorporeal therapy, Renal dysfunction, Renal failure, Renal injury",

author = "Murphy, {Heidi J.} and Jason Gien and Rashmi Sahay and Eileen King and Selewski, {David T.} and Bridges, {Brian C.} and Cooper, {David S.} and Fleming, {Geoffrey M.} and Paden, {Matthew L.} and Michael Zappitelli and Gist, {Katja M.} and Basu, {Rajit K.} and Jetton, {Jennifer G.} and David Askenazi",

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Murphy, HJ, Gien, J, Sahay, R, King, E, Selewski, DT, Bridges, BC, Cooper, DS, Fleming, GM, Paden, ML, Zappitelli, M, Gist, KM, Basu, RK, Jetton, JG & Askenazi, D 2021, 'Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately', Blood Purification, vol. 50, no. 6, pp. 808-817. https://doi.org/10.1159/000512538

TY - JOUR

T1 - Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately

AU - Murphy, Heidi J.

AU - Gien, Jason

AU - Sahay, Rashmi

AU - King, Eileen

AU - Selewski, David T.

AU - Bridges, Brian C.

AU - Cooper, David S.

AU - Fleming, Geoffrey M.

AU - Paden, Matthew L.

AU - Zappitelli, Michael

AU - Gist, Katja M.

AU - Basu, Rajit K.

AU - Jetton, Jennifer G.

AU - Askenazi, David

PY - 2021/9/1

Y1 - 2021/9/1

N2 - Introduction: We aimed to characterize acute kidney injury (AKI), fluid overload (FO), and renal replacement therapy (RRT) utilization by diagnostic categories and examine associations between these complications and mortality by category. Methods: To test our hypotheses, we conducted a retrospective multicenter, cohort study including 446 neonates (categories: 209 with cardiac disease, 114 with congenital diaphragmatic hernia [CDH], 123 with respiratory disease) requiring extracorporeal membrane oxygenation (ECMO) between January 1, 2007, and December 31, 2011. Results: AKI, FO, and RRT each varied by diagnostic category. AKI and RRT receipt were most common in those neonates with cardiac disease. Subjects with CDH had highest peak %FO (51% vs. 28% cardiac vs. 32% respiratory; p < 0.01). Hospital survival was 55% and varied by diagnostic category (45% cardiac vs. 48% CDH vs. 79% respiratory; p < 0.001). A significant interaction suggested risk of mortality differed by diagnostic category in the presence or absence of AKI. In its absence, diagnosis of CDH (vs. respiratory disease) (OR 3.04, 95% CL 1.14-8.11) independently predicted mortality. In all categories, peak %FO (OR 1.20, 95% CL 1.11-1.30) and RRT receipt (OR 2.12, 95% CL 1.20-3.73) were independently associated with mortality. Discussion/Conclusions: Physiologically distinct ECMO diagnoses warrant individualized treatment strategies given variable incidence and effects of AKI, FO, and RRT by category on mortality.

AB - Introduction: We aimed to characterize acute kidney injury (AKI), fluid overload (FO), and renal replacement therapy (RRT) utilization by diagnostic categories and examine associations between these complications and mortality by category. Methods: To test our hypotheses, we conducted a retrospective multicenter, cohort study including 446 neonates (categories: 209 with cardiac disease, 114 with congenital diaphragmatic hernia [CDH], 123 with respiratory disease) requiring extracorporeal membrane oxygenation (ECMO) between January 1, 2007, and December 31, 2011. Results: AKI, FO, and RRT each varied by diagnostic category. AKI and RRT receipt were most common in those neonates with cardiac disease. Subjects with CDH had highest peak %FO (51% vs. 28% cardiac vs. 32% respiratory; p < 0.01). Hospital survival was 55% and varied by diagnostic category (45% cardiac vs. 48% CDH vs. 79% respiratory; p < 0.001). A significant interaction suggested risk of mortality differed by diagnostic category in the presence or absence of AKI. In its absence, diagnosis of CDH (vs. respiratory disease) (OR 3.04, 95% CL 1.14-8.11) independently predicted mortality. In all categories, peak %FO (OR 1.20, 95% CL 1.11-1.30) and RRT receipt (OR 2.12, 95% CL 1.20-3.73) were independently associated with mortality. Discussion/Conclusions: Physiologically distinct ECMO diagnoses warrant individualized treatment strategies given variable incidence and effects of AKI, FO, and RRT by category on mortality.

KW - Continuous renal replacement therapy

KW - Extracorporeal membrane oxygenation

KW - Extracorporeal therapy

KW - Renal dysfunction

KW - Renal failure

KW - Renal injury

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Acute Kidney Injury, Fluid Overload, and Renal Replacement Therapy Differ by Underlying Diagnosis in Neonatal Extracorporeal Support and Impact Mortality Disparately

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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