IFKF

The case of neonatal acute kidney injury: Don't forget the babies!

 
David J. Askenazi
Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, USA
 
Jennifer R. Charlton
University of Virginia Children’s Hospital, Charlottesville, Virginia, USA
 
Ronnie Guillet
MD, Golisano Children’s Hospital, University of Rochester, Rochester, New York, USA

Extraordinary advances in neonatal care have markedly reduced the mortality of infants hospitalized in neonatal intensive care units (NICU). In the last few years, more publications, presentations and workshops have focused on kidney health in the NICU and its potential long-term renal health implications. Multiple single center reports suggest that neonatal acute kidney injury (AKI) is common and portends poor outcomes. These data are consistent with publications in adults and children suggesting that critically-ill patients do not just die from AKI, rather, AKI and fluid overload directly impact outcomes.1 Neonatal AKI is not only associated with increased mortality and length of stay,2 there is expanding evidence that NICU graduates are at risk of chronic kidney disease (CKD).

CKD affects millions of children and adults across the world and, like many adulthood diseases, may have its origins in early life. NICU graduates are at risk of developing CKD. Yet, the magnitude, underlying risk factors, and pathophysiology of the problem have not been fully elucidated. Existing studies suggest CKD in NICU survivors may be due to antenatal factors and postnatal exposures. Because glomerulogenesis continues into 34-36 weeks of post-conception, premature delivery disrupts nephrogenesis, leaving premature infants ‘primed’ for AKI and CKD.3 Previously, it was assumed that after an episode of AKI the kidney would recover kidney function completely. However, recent data from animals, children and adults with AKI suggest that survivors are indeed at risk of developing CKD.4 The full impact of AKI events during the first weeks of life on long-term kidney and health outcomes is not yet known.

Given the current state of AKI knowledge and the unique conditions of the neonate in the ICU, multiple questions about neonatal kidney health remain unanswered. Which neonates are at most risk of AKI and CKD? How do we improve our ability to recognize neonatal AKI earlier in the disease process? What clinical risk factors, nutritional, genetic, and environmental factors determine kidney health and/or disease? How do we recognize and prevent fluid overload in critically-ill neonates? What interventions can be used to prevent AKI and CKD and the consequences of failed organ function? What is the role of renal support devices in the care of critically-ill neonates with multi-organ failure? How is neonatal AKI different in those born in developed vs underdeveloped countries?

To answer these questions, several exciting initiatives are underway which promise to improve our understanding of neonatal AKI and enhance our ability to care for neonates with AKI. Groups such as the Neonatal Kidney Collaborative (neonatologists and pediatric nephrologists dedicated to improving neonatal kidney health) have formed and are conducting research on large international multi-center cohort studies. The NKC recently completed a 24-center multi-institutional study called Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN)5. Data from over 2000 sick neonates (born in 4 countries, across 24 centers) will allow investigators to understand the magnitude of the problem and have ample power to test whether AKI indeed portends poor outcomes after controlling for potential confounding variables. New devices, specifically designed to provide renal support therapy for neonates, have been developed and are currently being tested. These devices promise to enhance the ability to provide safe and reliable care to even the smallest infants. These advances will help improve the clinician’s ability to prevent, treat, support and prognosticate outcomes in vulnerable neonates at risk of kidney disease.

 

  1. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N.Engl.J.Med. 2017;376:11-20

  2. Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, et al. Neonatal Acute Kidney Injury. Pediatrics 2015;136:e463-73

  3. Carmody JB, Charlton JR. Short-term gestation, long-term risk: prematurity and chronic kidney disease. Pediatrics 2013;131:1168-79

  4. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int. 2012;82:516-24

  5. Jetton JG, Guillet R, Askenazi DJ, Dill L, Jacobs J, Kent AL, et al. Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study. Front.Pediatr. 2016;4:6

 

Source: http://thelancet.com/campaigns/kidney/updates/case-of-neonatal-acute-kidney-injury 

Research released today in light of World Kidney Day 2017 has revealed that that 55% of people in the UK with the most common risk factors for kidney disease (vascular disease, high blood pressure or diabetes) said they do not consider themselves to be at risk of kidney disease,

Read more on kidneyresearchuk.org news page: New survey finds 55% of people in UK at greatest risk of kidney disease are unaware of the risk they face.

 ‘Kidney’ was the word on thousands of lips on 9 March this year. Fundraisers and volunteers all around the UK took to the streets, hospitals and the airwaves to raise awareness of kidney disease and drum up support for the kidney cause as part of World Kidney Day. 

Read more on kidneyresearchuk.org news page: Creating a World Kidney Day wow!

13th Congress of The Arab Society of Nephrology and Renal Transplantation &
35th Annual Congress of The Egyptian Society of Nephrology and Transplantation

Read more on our reginal meeting page

 

Celebrate World Kidney Day and GET MOVING!
On March 9, 2017, we invite everyone to get up and get moving to celebrate their kidneys.
“#move4kidneys” is a symbolic gesture to remember that kidneys are vital organs and that they should be taken care of. This action urges everyone around the globe, from all cultures and ages, to keep fit and active.

You can find more information on the website: http://www.worldkidneyday.org/2017-campaign/move4kidneys/

World Kidney Day (WKD) is a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF).

Since the first campaign over eleven years ago, World Kidney Day (WKD) has turned into a global phenomenon. On March 9, 2017, medical professionals, government officials, the general public, celebrities and patients will take action locally. Past World Kidney Days have seen more than 600 events in well over 90 countries participating in the World Kidney Day celebrations!

Find more information the website http://www.theisn.org/advocacy/world-kidney-day

Partners

 

World Kidney Day (WKD) is an annual global awareness and education event, held on the second Thursday in March. Every year, countless local, national and international events are organised by kidney charities, healthcare professionals, patient groups and individuals who want to make a difference.

The 2017 theme is ‘Kidney Disease and Obesity'.

 

You will find more information on http://www.worldkidneyday.co.uk/

 

On June 8th, three main Dutch health insurance companies; Zilveren Kruis, Menzis & CZ, signed a contract to participate for €6,8 million in the initiative of the Dutch Kidney Foundation (DKF) to develop a portable artificial kidney (PAK). The PAK will be designed as a compact haemodialysis machine suitable for daily and nocturnal dialysis outside of hospital. It should give patients more freedom to dialyse anywhere and anytime to like. Our motto is ‘the dialysis treatment should be compliant to the patient and not the other way around’. The investment of the companies will make it possible to build a prototype which should be ready for clinical testing by the end of 2017.

Cooperation of three insurance companies is unique and also will be a great help to prepare the integration of the portable artificial in the insurance packages.

We expect that with a PAK, the therapy can be up to 40% cheaper (depending on the degree of self-sufficiency). The PAK will lower the barrier to self-dialysis, because the machine is less intrusive and more flexible in use.

Additional information