The Effect of Bumetanide in Extremely Low Birth Weight Infants with Acute Kidney Injury during their first Weeks of Life

Abstract

Background: To determine the effect of Bumetanide (Btd) in Extremely Low Birth Weight (ELBW) infants with Acute Kidney Injury (AKI). Methods: In a retrospective case control study, medical records of all ELBW infants born at our institution (1-1-00 and 1-1-13) and developed AKI were reviewed. Results: 96 ELBW infants were enrolled. Infants who received Btd (n=33) had a lower Birth Weight and higher severity of illness scores at birth than their controls (n=63) [589.0±117.7 vs. 672.3±156.9; p=0.004 and 59.5±15.6 vs. 50.6±17.4; p=0.01 respectively]. 24 hours following the onset of AKI, the urine output increased from 1.5 ± 2.4 to 6.1 ± 9.8 ml/kg/hour (p=0.01) in the Btd group, and from 2.5 ± 2.4 to 3.3 ± 2.9 ml/kg/h (p=0.08) in the control group. The change in 24-hour urine output was significantly higher in the Btd group than the control group [urine output increased by 4.4±9.6 vs. 0.7±3.3 ml/kg/h during the first 24 h of the onset of AKI respectively; p=0.047]. To adjust for possible confounders, a backward linear regression analysis was conducted, Btd was found to be the only independent variable associated with an increase in urine output during the first 24 hours following the onset of AKI (R2=0.114; p=0.005). During the following week, infants who received Btd developed higher serum creatinines than their controls [General Linear Model (GLM); p=0.033]. At discharge, there were no significant differences in serum creatinines between survivors. Conclusions: In ELBW infants with AKI, Btd improved urine output at the expense of increasing serum creatinine