Poor hemodynamic profile is associated with acute kidney injury in very low birth weight infants

Background Survivors of acute kidney injury (AKI) in very low birth weight (VLBW) infants may be at risk of developing chronic kidney disease in the long term. Large cohort studies examining risk factors associated with AKI in VLBW infants are scarce. Methods We retrospectively investigated the risk factors for the development of AKI by comparing the file records of VLBW infants (<1500 g) born between 2019 and 2022 and admitted to the neonatal intensive care unit with and without AKI. Results Of the 218 VLBW infants enrolled, 35 (16%) developed AKI. The AKI group had lower gestational age (25.3 vs. 28.9 weeks) and birth weight (760 g vs. 1060 g) compared to the no AKI group ( p < 0.001). Longer duration of mechanical ventilation, higher rates of inotrope and vancomycin therapy, patent ductus arteriosus (PDA), grade 2–3 necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (IVH) were more common in the AKI group ( p < 0.001). In multivariate analysis, gestational age (OR 0.70, 95% CI 0.50–0.98, p = 0.036) and inotrope use ≥3 days (OR 6.13, 95% CI 2.06–18.25, p = 0.001) were independently associated with AKI. Conclusion Hypotension is a strong predictor of the development of AKI in VLBW infants in the NICU. Our findings highlight the importance of early identification of high‐risk neonates and closer hemodynamic monitoring to prevent AKI in very preterm infants.