Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation

doi:10.1038/s41372-022-01424-3

Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation

Pediatrics

Producción científica: Article › revisión exhaustiva

17 Citas (Scopus)

Resumen

Objective: To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association. Study design: Secondary analysis of AWAKEN multicenter retrospective cohort. Exposures: AKI severity and diagnostic criteria. Outcome: AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation. Results: Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5–109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3–95.3%) of the total effect of AKI diagnostic criteria on documentation. Conclusion: We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.

Idioma original	English
Páginas (desde-hasta)	930-936
Número de páginas	7
Publicación	Journal of Perinatology
Volumen	42
N.º	7
DOI	https://doi.org/10.1038/s41372-022-01424-3
Estado	Published - jul 2022

Nota bibliográfica

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.

Financiación

Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings and for the Neonatal Kidney Collaborative (NKC) steering committee annual meeting at The University of Alabama at Birmingham (UAB), as well as support for 2 of the AWAKEN study investigators at UAB (D.A. and R.G.). PICAN is part of the Department of Pediatrics at UAB and is funded by Children’s of Alabama hospital, UAB Department of Pediatrics, UAB School of Medicine, and UAB Center for Clinical and Translational Sciences (National Institutes of Health grant UL1TR001417). Finally, the AWAKEN study at The University of New Mexico was supported by the Clinical and Translational Science Center at The University of New Mexico (National Institutes of Health grant UL1TR001449) and by The University of Iowa Institute for Clinical and Translational Science (grant U54TR001356). The AWAKEN study investigators at the Canberra Hospital at the Australian National University Medical School were supported by the Canberra Hospital Private Practice Fund, and investigators at University of Virginia Children’s Hospital were supported by a 100 Women Who Care Grant from the 100 Women Charitable Foundation. The funding sources for this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. For full disclosure, we provide the additional list of authors’ other funding not directly related to this study. DA consults for and received research/education grants with Baxter, Medtronic, Nuwellis, Bioporto and Seastar. He has patent pending inventions in the area of neonatal nephrology. AS reports receiving grant funding for studies not related to this work, grants NHLBI K23 HL148394, L40 HL148910, and R01 HL146818. MS is supported in part by the Indiana University School of Medicine Physician Scientist Initiative. No other disclosures were reported.

Financiadores	Número del financiador
University of Alabama, Birmingham
100 Women Charitable Foundation
Children's of Alabama
Indiana University School of Medicine
National Institutes of Health (NIH)
Center for Clinical and Translational Science, University of Alabama at Birmingham
National Heart, Lung, and Blood Institute (NHLBI)	R01HL146818, K23HL148394, L40HL148910
National Center for Advancing Translational Sciences (NCATS)	U54TR001356, UL1TR001417, UL1TR001449
New Mexico State University, New York University	UL1TR001449
Indiana Clinical and Translational Sciences Institute	U54TR001356

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

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10.1038/s41372-022-01424-3

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@article{6225b01d48cd426ea0125fedac511994,

title = "Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation",

abstract = "Objective: To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association. Study design: Secondary analysis of AWAKEN multicenter retrospective cohort. Exposures: AKI severity and diagnostic criteria. Outcome: AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation. Results: Among 605 neonates with AKI, 13\% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5\% vs. 51\%, p < 0.001) and SCr-only AKI (76.9\% vs. 50.1\%, p = 0.04). Nephrology consultation mediated 78.0\% (95\% CL 46.5{\textendash}109.4\%) of the total effect of AKI severity and 82.8\% (95\% CL 70.3{\textendash}95.3\%) of the total effect of AKI diagnostic criteria on documentation. Conclusion: We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.",

author = "Jennifer Chmielewski and Chaudhry, \{Paulomi M.\} and Harer, \{Matthew W.\} and Shina Menon and South, \{Andrew M.\} and Ashley Chappell and Russell Griffin and David Askenazi and Jennifer Jetton and Starr, \{Michelle C.\} and Namasivayam Ambalavanan and Selewski, \{David T.\} and Subrata Sarkar and Alison Kent and Jeffery Fletcher and Abitbol, \{Carolyn L.\} and Marissa DeFreitas and Shahnaz Duara and Charlton, \{Jennifer R.\} and Swanson, \{Jonathan R.\} and Ronnie Guillet and Carl D{\textquoteright}Angio and Ayesa Mian and Erin Rademacher and Mhanna, \{Maroun J.\} and Rupesh Raina and Deepak Kumar and Jetton, \{Jennifer G.\} and Brophy, \{Patrick D.\} and Colaizy, \{Tarah T.\} and Klein, \{Jonathan M.\} and Arikan, \{Ayse Akcan\} and Rhee, \{Christopher J.\} and Goldstein, \{Stuart L.\} and Nathan, \{Amy T.\} and Kupferman, \{Juan C.\} and Alok Bhutada and Shantanu Rastogi and Elizabeth Bonachea and Susan Ingraham and John Mahan and Arwa Nada and Cole, \{F. Sessions\} and Davis, \{T. Keefe\} and Joshua Dower and Lawrence Milner and Alexandra Smith and Mamta Fuloria and Chishti, \{Aftab S.\} and Hanna, \{Mina H.\}",

note = "Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.",

year = "2022",

month = jul,

doi = "10.1038/s41372-022-01424-3",

language = "English",

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AU - Chmielewski, Jennifer

AU - Chaudhry, Paulomi M.

AU - Harer, Matthew W.

AU - Menon, Shina

AU - South, Andrew M.

AU - Chappell, Ashley

AU - Griffin, Russell

AU - Askenazi, David

AU - Jetton, Jennifer

AU - Starr, Michelle C.

AU - Ambalavanan, Namasivayam

AU - Selewski, David T.

AU - Sarkar, Subrata

AU - Kent, Alison

AU - Fletcher, Jeffery

AU - Abitbol, Carolyn L.

AU - DeFreitas, Marissa

AU - Duara, Shahnaz

AU - Charlton, Jennifer R.

AU - Swanson, Jonathan R.

AU - Guillet, Ronnie

AU - D’Angio, Carl

AU - Mian, Ayesa

AU - Rademacher, Erin

AU - Mhanna, Maroun J.

AU - Raina, Rupesh

AU - Kumar, Deepak

AU - Jetton, Jennifer G.

AU - Brophy, Patrick D.

AU - Colaizy, Tarah T.

AU - Klein, Jonathan M.

AU - Arikan, Ayse Akcan

AU - Rhee, Christopher J.

AU - Goldstein, Stuart L.

AU - Nathan, Amy T.

AU - Kupferman, Juan C.

AU - Bhutada, Alok

AU - Rastogi, Shantanu

AU - Bonachea, Elizabeth

AU - Ingraham, Susan

AU - Mahan, John

AU - Nada, Arwa

AU - Cole, F. Sessions

AU - Davis, T. Keefe

AU - Dower, Joshua

AU - Milner, Lawrence

AU - Smith, Alexandra

AU - Fuloria, Mamta

AU - Chishti, Aftab S.

AU - Hanna, Mina H.

PY - 2022/7

Y1 - 2022/7

N2 - Objective: To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association. Study design: Secondary analysis of AWAKEN multicenter retrospective cohort. Exposures: AKI severity and diagnostic criteria. Outcome: AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation. Results: Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5–109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3–95.3%) of the total effect of AKI diagnostic criteria on documentation. Conclusion: We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.

AB - Objective: To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association. Study design: Secondary analysis of AWAKEN multicenter retrospective cohort. Exposures: AKI severity and diagnostic criteria. Outcome: AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation. Results: Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5–109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3–95.3%) of the total effect of AKI diagnostic criteria on documentation. Conclusion: We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.

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Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation

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