The global prevalence of acute kidney injury (AKI) in preterm neonates: an epidemiological meta-analysis.

Abstract

Acute kidney injury (AKI) in preterm neonates is a serious pathology linked to the neonatal mortality rate. Since there is no comprehensive systematic review and meta-analysis in this regard, this study aimed to investigate the global prevalence of AKI in preterm neonates. A comprehensive literature search was conducted using MeSH-based keywords across multiple databases (by August 22, 2025). Eligibility criteria were considered via the PRISMA guideline, and quality assessment was applied using the STROBE checklist. Following data extraction, meta-analysis was applied using CMA (v.3) software. Heterogeneity was assessed using the I² test, publication bias was evaluated via the Egger test and funnel plots, and subgrouping and sensitivity analyses were considered to ensure result robustness. Data were presented as 95% CI, and p < 0.05 was considered a significant level. Following the assessment of 1032 records, 26 eligible investigations with a total number of 1,328,711 preterm neonates admitted to NICU were selected. 21,568 cases were diagnosed with AKI; thus, the global prevalence of AKI in preterm neonates admitted to NICU was 17.8% (95% CI: 8.6%-33.2%, I² = 99.8%, p < 0.001). Subgroup analyses demonstrated regional variations in prevalence, including 18.3% in Africa, 18.5% in America, 15.2% in Asia, and 20.1% in Europe. Meta-regression found no significant temporal trend in AKI prevalence over the study years.<h4>Conclusion</h4> According to the findings, it is essential to monitor the renal health status in preterm infants admitted to the NICU. Failure to undergo preterm screening can lead to long-term kidney issues in adulthood.<h4>What is known</h4>• AKI is a major complication among preterm neonates and contributes to neonatal morbidity and mortality. • Diagnosis of AKI in neonates is challenging due to varying definitions and inconsistent use of biomarkers.<h4>What is new</h4>• This study included over 1.3 million preterm neonates, establishing a pooled AKI prevalence of 17.8%. • Africa (15.2%) and Europe (20.1%) comprise the lowest and the highest rates of AKI, respectively.