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Both fluid overload and dehydration can lead to AKI. Our aim was to examine the associations between early fluid and sodium intake and AKI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study comprised 421 VLBW infants born at\u2009&lt;\u200932\u00a0weeks. Detailed data on fluid management during the first 24\u00a0h of life, diuresis and weight changes during the first postnatal week and plasma creatinine measurements during the first 2 postnatal weeks were acquired from an electronic patient information system. AKI was defined according to the KDIGO definition modified for neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The incidence of AKI was 8.6%, and on average, it was diagnosed on the fifth postnatal day. Higher total fluid intake (mL\/kg\/24\u00a0h) during the first day of life was associated with an increased risk of AKI (OR, 1.015; 95% CI, 1.005\u20131.025;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), analysis adjusted for gestational age and being small-for-gestational age. The highest fluid intake quartile had a 5.6-fold risk of developing AKI when compared with the lowest quartile (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). A higher total sodium intake (mmol\/kg\/24\u00a0h) was associated with an increased risk of AKI (OR, 1.12; 95% CI, 1.03\u20131.21;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Among infants with AKI, a substantial proportion of early fluid and sodium intake (median 27% and 59% of total intake, respectively) originated from volume expanders. Infants diagnosed with AKI exhibited an average weight gain of\u2009+\u20092.8% by the second day of life.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As  part of efforts to minimize the risk of AKI, avoiding excessive fluid and sodium administration during the first postnatal hours may be beneficial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-025-07049-w","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T15:26:00Z","timestamp":1763652360000},"page":"1191-1201","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["High early fluid and sodium intake as risk factors for acute kidney injury in very-low-birthweight infants"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2813-7709","authenticated-orcid":false,"given":"Pauliina M.","family":"M\u00e4kel\u00e4","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lotta","family":"Immeli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Leskinen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reijo","family":"Sund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Jahnukainen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sture","family":"Andersson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e4ivi","family":"Luukkainen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"7049_CR1","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1203\/PDR.0b013e31820b95ca","volume":"69","author":"R Koralkar","year":"2011","unstructured":"Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D (2011) Acute kidney injury reduces survival in very low birth weight infants. 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