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. 2022 Oct;42(10):1353-1360.
doi: 10.1038/s41372-021-01260-x. Epub 2021 Nov 13.

Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study

Abby M Basalely  1   2 , Russell Griffin  3 , Katja M Gist  4 , Ronnie Guillet  5 , David J Askenazi  3 , Jennifer R Charlton  6 , David T Selewski  7 , Mamta Fuloria  8 , Frederick J Kaskel  9 , Kimberly J Reidy  9 ; AWAKEN Study Group
Collaborators, Affiliations

Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study

Abby M Basalely et al. J Perinatol. 2022 Oct.

Abstract

Objective: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality.

Study design: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models.

Result: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07-4.31), hypernatremia (HR 4.23, 95% CI 2.07-8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01-14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI.

Conclusion: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.

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Conflict of interest statement

Conflict of Interest:

Dr. Abby Basalely has consulted for impact communication partners. Dr. Kimberly Reidy is site investigator for Advicenne and Travere Therapeutics clinical trials unrelated to this study. Dr. Jennifer Charlton is co-owner of Sindri Technologies LLC. Dr. David J Askenazi declares no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. He does have the following 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 (AKI) Foundation (Cincinnati, OH, USA). David J Askenazi is a consultant for CHF solutions, and Medtronic.

Figures

Figure 1.
Figure 1.
Flowchart of inclusion and exclusion criteria. AWAKEN- Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN); GA – Gestational Age; w- Week
Figure 2.
Figure 2.
Hazard Ratios of Dysnatremia and Mortality in Cox Proportional Hazards Models, Combined and Stratified by Acute Kidney Injury (AKI) Status HR – Hazard Ratio, 95%CI- 95% Confidence interval Models were stratified by site and adjusted for gestational age, birthweight, chest compressions at birth, and time varying covariates of therapy with vasopressor/inotropes, diuretics, aminoglycosides and vancomycin.
See this image and copyright information in PMC

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