112 - Short- and Long-Term Kidney Outcomes in Children with Bronchopulmonary Dysplasia

Poster Number: 112

Michelle Starr, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN, United States; Samantha Wallace, Indiana University School of Medicine, Indianapolis, IN, United States; Erica Geers, Indiana University School of Medicine, Evansville, IN, United States; Jason Niehaus, Indiana University School of Medicine, Indianapolis, IN, United States; A. Ioana Cristea, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States

Background: Approximately 50,000 children are born prematurely in the United States annually. Bronchopulmonary dysplasia (BPD) is a common respiratory sequela of prematurity. Children born prematurely have a 3-fold increased risk of chronic kidney disease (CKD) compared to children born full-term. Children with BPD may be at increased risk of poor kidney outcomes, most notably CKD.

Objective: To describe short and long-term kidney outcomes in children with BPD. We hypothesized that children with BPD would have higher rates of CKD compared to those without BPD.

Design/Methods: We included all children enrolled in a longitudinal BPD Registry at our tertiary pediatric hospital from 1/2011-1/2021 and evaluated short and long-term kidney outcomes for children with information available in the electronic medical record. Our primary outcome was CKD, defined as an estimated glomerular filtration rate < 90 ml/min/1.73m2. Our secondary outcomes included: 1) albuminuria defined by urine albumin/creatinine ratio≥ 30 mg/g creatinine and 2) hypertension, defined as an elevated blood pressure with either systolic or diastolic blood pressures > 90%ile for height, age and sex.

Results:
Of the 862 children with BPD in the cohort, 741 had clinical and laboratory data available from their incident neonatal hospitalization. Of these, 40.2% (298/741) had an episode of acute kidney injury (AKI) and 65.2% (483/741) had a persistent elevation of their serum creatinine >0.6mg/dL at or after 14 days of life. Of those with AKI, 49% (146/298) had AKI appropriately identified by neonatology.

 

Of the 440 children with BPD who had follow-up within our healthcare system to at least 2 years of age, 29.8% developed CKD (Table 1). Most had mild CKD (85% with Stage 2, 14% with Stage 3 and 1% with Stage 4), and were diagnosed at a mean age of 2.8 years. Proteinuria and hypertension were less common, occurring in 8.4% and 12.9% respectively. Children with BPD who developed CKD were more likely to have neonatal AKI (53.4% vs 38.2%, P=0.003) and persistently elevated serum creatinine (67.2% vs 53.1%, P=0.006) than their non-CKD peers.
Conclusion(s):
In this large single center cohort of children with BPD, we describe high rates of CKD, suggesting that children with BPD may be at higher risk of long-term kidney outcomes. Children with BPD who developed CKD were more likely to have an episode of AKI during their neonatal hospitalization as well as persistent serum creatinine elevation. Further evaluation of the factors associated with development of CKD using prospective cohorts are needed.

Table 1Comparison of neonatal characteristics, neonatal course and follow-up by CKD status (determined by eGFR < 90ml/min/1.73m2)