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Urinary metabolomics predict acute kidney injury in very-low-birth-weight infants with patent ductus arteriosus

Very preterm infants with immature kidneys exhibit high vulnerability to acute kidney injury (AKI). While AKI is associated with adverse outcomes, serum-creatinine-based diagnostics prove unreliable in early risk assessment of kidney damage. This pilot study investigated 1H-NMR spectroscopy-based me...

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Main Authors: Niesert, Moritz (Author) , Cannet, Claire (Author) , Fichtner, Alexander (Author) , Hoffmann, Georg F. (Author) , Okun, Jürgen G. (Author) , Pituk, Dóra (Author) , Gille, Christian (Author) , Pöschl, Johannes (Author) , Waldherr, Sina (Author) , Ziegler, Andreas (Author) , Westhoff, Jens (Author)
Format: Article (Journal)
Language:English
Published: 5 March 2026
In: Biomolecules
Year: 2026, Volume: 16, Issue: 3, Pages: 1-16
ISSN:2218-273X
DOI:10.3390/biom16030391
Online Access:Resolving-System, kostenfrei, Volltext: https://doi.org/10.3390/biom16030391
Verlag, kostenfrei, Volltext: https://www.mdpi.com/2218-273X/16/3/391
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Author Notes:Moritz Niesert, Claire Cannet, Alexander Fichtner, Georg F. Hoffmann, Jürgen G. Okun, Dóra Pituk, Christian Gille, Johannes Pöschl, Sina Waldherr, Andreas Ziegler and Jens H. Westhoff
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Summary:Very preterm infants with immature kidneys exhibit high vulnerability to acute kidney injury (AKI). While AKI is associated with adverse outcomes, serum-creatinine-based diagnostics prove unreliable in early risk assessment of kidney damage. This pilot study investigated 1H-NMR spectroscopy-based metabolomics for the identification of very-low-birth-weight (VLBW < 1500 g) infants at risk of AKI before and during indomethacin treatment for patent ductus arteriosus (PDA). Longitudinal urine samples (0 h, 12 h, 36 h, 84 h, 120 h, 14 d, 28 d) from 12 VLBW infants receiving indomethacin for hemodynamically significant PDA were analyzed by 1H-NMR spectroscopy. In total, 150 urinary metabolites were annotated and single-metabolite and multivariate analyses were performed. At 36 h after treatment initiation, three patients (25%) developed AKI (KDIGO criteria). Principal component analysis (PCA) revealed significant differences in urinary metabolic profiles between the AKI and non-AKI groups 12 h after indomethacin initiation. Before treatment, five metabolites were significantly lower in the AKI group: adenine, creatine, dimethylglycine, 1-methylnicotinamide, and methylmalonic acid. Urinary creatine/creatinine (AUC 0.97) and 1-methylnicotinamide/creatinine (AUC 0.93) exhibited promising prognostic accuracy for the prediction of AKI. 1-methylnicotinamide/creatinine concentrations remained persistently reduced during the study. In conclusion, urinary metabolomics, particularly creatine and 1-methylnicotinamide levels, may serve as valuable non-invasive biomarkers for identifying VLBW infants at risk of AKI.
Item Description:Gesehen am 02.06.2026
Physical Description:Online Resource
ISSN:2218-273X
DOI:10.3390/biom16030391

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