Fatores de risco de mortalidade em recém-nascidos com anomalias congênitas dos rins e do trato urinário

Abstract

Purpose: To investigate predictive factors associated with early mortality in newborns with congenital anomalies of the kidney and urinary tract (CAKUT). Materials and Methods: This study included a cohort of neonates with CAKUT born at a tertiary hospital between 1996 and 2021. Controls were matched with CAKUT cases by sex, time (subsequent newborn of the same sex), and place of birth at a ratio of approximately 2:1. The covariates included in the analysis were sex, gestational age, birth weight, neonatal classification, and birth order. CAKUT was categorized into four phenotypes: urinary tract dilatation (UTD), lower urinary tract obstruction (LUTO), cystic diseases, and agenesis/hypodysplasia. The primary outcome was neonatal mortality. Survival analysis was performed using the Cox proportional hazards model. Results: 857 cases and 1,755 controls were analyzed. The overall early mortality rate was 7.2%. After controlling for confounding, CAKUT exhibited a higher risk of early mortality than the controls (hazard ratio [HR], 25.1; 95%CI, 14.0 – 45.2). The following covariates were independently associated with early mortality: prematurity (HR, 1.7; 95%CI, 1.2 – 2.5), LBW (HR, 2.4; 95%CI, 1.6 – 2.5), VLBW (HR, 2.9; 95%CI, 1.7 – 1.1), oligohydramnios (HR, 3.2; 95%CI, 2.2 – 4.8), cystic diseases (HR, 3.8; 95%CI, 2.3 – 6.4), LUTO (HR, 5.1; 95%CI, 3.0 – 8.5), renal agenesis/hypodysplasia (HR, 5.1; 95%CI, 2.9 – 8.7), and extrarenal malformations (HR, 2.6; 95%CI, 1.7 – 3.9). Conclusions: Newborns with CAKUT had higher mortality rate than controls. Factors including prematurity, LBW, oligohydramnios, extrarenal malformations, and CAKUT phenotypes with kidney involvement were associated with increased mortality risk.