The Impact of Erythropoietin on Short- and Long-Term Kidney-Related Outcomes in Neonates of Extremely Low Gestational Age. Results of a Multicenter, Double-Blind, Placebo-Controlled Randomized Clinical Trial Article

Askenazi, DJ, Heagerty, PJ, Schmicker, RH et al. (2021). The Impact of Erythropoietin on Short- and Long-Term Kidney-Related Outcomes in Neonates of Extremely Low Gestational Age. Results of a Multicenter, Double-Blind, Placebo-Controlled Randomized Clinical Trial . JOURNAL OF PEDIATRICS, 10.1016/j.jpeds.2021.01.031

cited authors

  • Askenazi, DJ; Heagerty, PJ; Schmicker, RH; Brophy, P; Juul, SE; Goldstein, SL; Hingorani, S; Comstock, BA; Wadhawan, R; Mayock, DE; Courtney, SE; Robinson, T; Ahmad, KA; Bendel-Stenzel, E; Baserga, M; LaGamma, EF; Downey, LC; Rao, R; Fahim, N; Lampland, A; Frantz, ID; Khan, JY; Weiss, M; Gilmore, MM; Ohls, R; Srinivasan, N; Perez, JE; McKay, V; Vu, PT; Thomas, B; Elhassan, N; Mulkey, S; Dydynski, P; Vijayamadhavan, VK; Mulrooney, N; Yoder, B; Kase, JS; Check, J; Gogcu, S; Osterholm, E; Ramel, S; Bendel, C; Gale, C; George, T; Georgieff, M; Gisslen, T; Guiang, S; Hall, A; Johnson, D; Pfister, K; Podgorski, H; Roberts, K; Stepka, E; Engel, M; Kamrath, H; Scheurer, J; Hanson, A; Satrom, K; Pfister, S; Simones, A; Plummer, E; Zorn, E; Martin, CR; O'Reilly, D; Porta, N; Bazacliu, C; Williams, J; Rajderkar, D; Northington, F; Valdez, RC; Beauman, S; Saurabhkumar, P; Diaz-Barbosa, M; Serize, A; Jordan, J; Ott, D; Mora, AF; Hedrick, P; Flynn, V; Silvia, A; Clopp, B; Feltner, JB; Esposito, I; Hauge, S; Nikirk, S; Purnell, A; Loy, E; Sikes, N; Mason, M; McConnell, J; Brown, T; Harrison, H; Pearson, D; Drake, T; Wright, J; Walden, D; Guy, A; Nason, J; Talbot, M; Lee, K

authors

abstract

  • Objective: To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22-26 months of corrected gestational age (cGA) compared with those randomized to placebo. Study design: We performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. Results: The prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine/cystatin C values at days 0, 7, 9, and 14). At 22-26 months of cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2, 35.8% had urine albumin/creatinine ratio >30 mg/g, 23% had a systolic blood pressure (SBP) >95th percentile for age, and 40% had a diastolic blood pressure (DBP) >95th percentile for age. SBP >90th percentile occurred less often among recipients of erythropoietin (P < .04). This association remained even after controlling for gestational age, site, and sibship (aOR 0.6; 95% CI 0.39-0.92). We did not find statistically significant differences between treatment groups in eGFR, albumin/creatinine ratio, rates of SBP >95th percentile, or DBP >90th or >95th percentiles at the 2 year follow-up visit. Conclusions: ELGANs have high rates of in-hospital AKI and kidney-related problems at 22-26 months of cGA. Recombinant erythropoietin may protect ELGANs against long-term elevated SBP but does not appear to protect from AKI, low eGFR, albuminuria, or elevated DBP at 22-26 months of cGA.

publication date

  • January 1, 2021

published in

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