ESPN 53rd Annual Meeting

ESPN 2021


 
Postnatal maturation of glomerular filtration rate in term born neonates: an individual participant data meta-analysis.
NORI SMEETS 1 JOANNA INTHOUT 1 MAURICE VAN DER BURGH 1 GEORGE SCHWARTZ 2 MICHIEL SCHREUDER 1 SASKIA DE WILDT 1

1- RADBOUD UNIVERSITY MEDICAL CENTER
2- UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE
 
Introduction:

The evidence from individual studies to support the maturational pattern of measured glomerular filtration rate (GFR) in healthy term born neonates is inconclusive. This hampers the delineation between normal and abnormal kidney development as well as the diagnosis of acute kidney injury (AKI). Thus, we aimed to describe GFR maturation in the first month of life using an individual participant data meta-analysis (IPDMA) of measured GFR data.

Material and methods:

The Pubmed and ClinicalTrials.gov databases were searched to identify studies reporting mGFR as measured by exogenous markers or creatinine clearance (CrCL) in healthy term born neonates. Articles were subsequently reviewed using Rayyan by two individual researchers. The relationship between postnatal age and clearance was investigated using penalized splines with generalized additive linear mixed models on individual data, taking into account clustering by study. Data from aggregated results were simulated to exactly reflect the reported mean/median and SD.

Results:

1521 articles were screened and 50 relevant studies reported mGFR in healthy term born neonates. In total, 1055 measured GFR values from 958 neonates were included. IPD were available for 371 neonates and 587 neonates were represented by 46 summarizing datapoints as means/medians per cohort. On average, GFR increases rapidly in the first five days after birth from a value of 20.1 (95% CI 16.1-24.1) ml/min/1.73m2 at the first day to 37.6 at day 5 (95% CI 34.2-40.9), followed by a more steady increase to 57.0 (95% CI 41.1-72.9) ml/min/1.73m2 at end of the fourth week.

Conclusions:

These normative values show a clear developmental pattern of GFR maturation in the first weeks of life and indicate a biphasic increase with the largest increase until day 5. Our IPDMA data can therefore serve as a useful baseline for neonatal GFR.