ArticlePediatric nephrology (Berlin, Germany)2025
Evaluation of acute kidney injury in preterm infants using serum creatinine decline in comparison with KDIGO criteria.
Article in Pediatric nephrology (Berlin, Germany), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Elevated serum creatinine over the first week of life and mortality risk in extremely preterm neonates: a secondary analysis of the Preterm Erythropoietin Neuroprotection Trial (PENUT).Pediatric nephrology (Berlin, Germany) · 2026Trial
- Acute kidney injury and early mortality in extremely preterm neonates born at 22-27 weeks gestation.Pediatric nephrology (Berlin, Germany) · 2026Article
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Authors and funding
6 authors.
Funding
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Abstract
backgroundAcute kidney injury (AKI) is commonly observed in critically ill neonates; however, early identification of AKI in the first week of life is challenging due to the influence of maternal serum creatinine (SCr). An alternative criterion proposed by Gupta et al. based on SCr decline may identify additional infants at risk beyond the KDIGO definition.
methodsWe retrospectively reviewed 409 infants with a gestational age < 32 weeks who were admitted to our NICU between 2018 and 2024. AKI was defined according to the KDIGO guidelines or the Gupta threshold for days 3, 5, or 7 SCr. We compared mortality, bronchopulmonary dysplasia (BPD), and length of hospital stay among the No-AKI, Gupta-only AKI, and KDIGO-AKI groups.
resultsAmong 409 infants, 145 (35.5%) had Gupta-only AKI, 9 (2.2%) had KDIGO-only AKI, and 54 (13.2%) had both definitions. The infants with AKI were premature and had lower birth weights than those without AKI. Both AKI groups showed higher rates of composite outcomes (mortality or BPD) than the No-AKI (p < 0.001) group. Gupta-only AKI was associated with prolonged stay (+ 10.1 days, p = 0.01) and increased odds of BPD (adjusted OR 2.12, p = 0.023), while KDIGO-AKI had a stronger association with mortality (27.0%, p < 0.001).
conclusionsThe Gupta definition identified a substantial subset of highly preterm infants at a higher risk of adverse outcomes who were missed using the KDIGO criteria. Integrating SCr level decline-based methods may improve early AKI detection and enhance outcomes in this vulnerable population.
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