Incidence, Risk Factors, and Outcomes of Neonatal Acute Kidney Injury: Protocol of a Multicentric Prospective Cohort Study [The Indian Iconic Neonatal Kidney Educational Registry]

Gopal Agrawal; Sanjay Wazir; Sidharth Kumar Sethi; Abhishek Tibrewal; Rohan Dhir; Naveen Bajaj; Naveen Parkash Gupta; Shishir Mirgunde; Jagdish Sahoo; Binesh Balachandran; Kamran Afzal; Anubha Shrivastava; Jyoti Bagla; Sushma Krishnegowda; Ananth Konapur; Kritika Soni; Vamsi Krishna Kolukula; Rupali Jangid; Timothy Bunchman; Rupesh Raina

doi:10.3389/fped.2021.690559

Incidence, Risk Factors, and Outcomes of Neonatal Acute Kidney Injury: Protocol of a Multicentric Prospective Cohort Study [The Indian Iconic Neonatal Kidney Educational Registry]

Front Pediatr. 2021 Jul 9:9:690559. doi: 10.3389/fped.2021.690559. eCollection 2021.

Authors

Gopal Agrawal¹, Sanjay Wazir¹, Sidharth Kumar Sethi², Abhishek Tibrewal³, Rohan Dhir², Naveen Bajaj⁴, Naveen Parkash Gupta⁵, Shishir Mirgunde⁶, Jagdish Sahoo⁷, Binesh Balachandran⁸, Kamran Afzal⁹, Anubha Shrivastava¹⁰, Jyoti Bagla¹¹, Sushma Krishnegowda¹², Ananth Konapur¹³, Kritika Soni², Vamsi Krishna Kolukula^{1

14}, Rupali Jangid^{1

14}, Timothy Bunchman¹⁵, Rupesh Raina³

Affiliations

¹ Department of Neonatology, Cloudnine Hospital, Gurgaon, India.
² Department of Paediatric Nephrology, The Medicity Hospital, Kidney Institute, Medanta, Gurgaon, India.
³ Akron's Children Hospital, Akron, OH, United States.
⁴ Department of Neonatology, Deep Hospital, Ludhiana, India.
⁵ Department of Neonatology, Madhukar Rainbow Children's Hospital, New Delhi, India.
⁶ Department of Paediatrics, Government Medical College, Miraj, India.
⁷ Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India.
⁸ Department of Neonatology, Aster Mims Hospital, Kottakkal, India.
⁹ Department of Paediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
¹⁰ Department of Paediatrics, Moti Lal Nehru Medical College, Prayagraj, India.
¹¹ Department of Paediatrics, ESI Post Graduate Institute of Medical Science Research, New Delhi, India.
¹² Department of Paediatrics, JSS Hospital, JSS Academy of Higher Education and Research, Mysuru, India.
¹³ Department of Paediatrics, Kalinga Institute of Medical Sciences Hospital, Kurnool, India.
¹⁴ THB, Sekhmet Technologies Pvt Ltd., Gurgaon, India.
¹⁵ Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States.

Abstract

Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is sparse. Neonatal AKI is an independent risk factor for increased mortality and prolonged hospital stay. There are stark differences in the epidemiology of AKI in neonates amongst the developing and the developed world. Increased prevalence of neonatal sepsis, lack of awareness about neonatal AKI and poor access to pediatric nephrologists add to the improper management of neonatal AKI in the developing countries. Methods: This study is a multicentric, national, prospective cohort study [The Indian iconic Neonatal Kidney Educational Registry (TINKER)] conducted in level 2-3 NICUs in 11 centers across India. We have enrolled nearly 2,000 neonates over the study period. Neonates (≤ 28 days) who were admitted in NICU and those who received intravenous (IV) fluids for at least 48 h for hydration and/or nutrition have been included. Data collection included: (1) baseline demographics (2) daily physiologic and laboratory parameters (3) discharge data. KDIGO workgroup AKI definition modified for neonates was used for defining AKI. Data entry was carried out by individual participating centers using a web-based database (akiregistry.org). De-identified data has been maintained and handled by the principal investigator (PI). This collaboration plans to disseminate data through peer-reviewed publications and through presentations at educational conferences. Conclusions: The purpose of this study is to create the first prospective neonatal all-cause AKI data repository and describe the incidence of neonatal AKI in NICUs in the country and determine the risk factors as well as the outcomes of such neonates-both short-term and long-term outcomes. This will eventually spur therapeutic advancements, facilitate decipherment of epidemiological trends, risk factors as well as outcomes and identify disparities in management across the nation.

Keywords: KDIGO; acute kidney injury; creatinine; neonatal AKI; urine output.