Acute Kidney Injury Diagnostic Accuracy and Implications of Different Baseline Creatinine Equations
Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New equations (the AKI Baseline Creatinine [ABC] methods) for estimating Crb were derived from children without kidney disease. We aimed to externally validate ABC...
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| Published in: | Kidney international reports Vol. 10; no. 10; pp. 3444 - 3455 |
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| Abstract | Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New equations (the AKI Baseline Creatinine [ABC] methods) for estimating Crb were derived from children without kidney disease. We aimed to externally validate ABC methods in an international cohort and assess how different Crb equations alter AKI epidemiology.
AWARE was a prospective international study of critically ill children (aged 0–25 years) from 32 pediatric intensive care units (ICUs). A subset of AWARE (n = 2451) with known Crb (gold standard) was used to validate ABC methods using statistical measures of precision (R2) and accuracy (within 10% or 30% of gold standard). The entire cohort (N = 4984) was used to determine how different Crb estimating equations (3 ABC equations and 4 published estimated glomerular filtration rate [eGFR] equations imputing Crb) impact AKI incidence and its association with key clinical outcomes, including 28-day mortality, using univariate and multivariate analysis.
The ABC-Age equation (requiring only age) demonstrated similar accuracy and precision compared with existing Crb equations. The ABC-Creatinine equation (includes age and hospital creatinine value) outperformed existing Crb equations by up to 15% in precision (ABC-Creatinine, R2 = 0.51 vs. full-age spectrum [FAS], R2 = 0.36) and 32% in accuracy (ABC-Creatinine, 66% vs. original Schwartz, 34%). For the entire cohort, AKI incidence varied from 7% to 12%, depending on Crb definition. ABC equations were associated with clinical outcomes similarly to existing Crb equations.
ABC-Creatinine equation (with minimal variables) outperformed existing Crb equations for accuracy and precision as the optimal method for Crb estimation. Crb definition variability alters AKI incidence and epidemiology, necessitating standardization.
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| AbstractList | Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Cr
), unavailable in up to 75% of hospitalized children. New equations (the AKI Baseline Creatinine [ABC] methods) for estimating Cr
were derived from children without kidney disease. We aimed to externally validate ABC methods in an international cohort and assess how different Cr
equations alter AKI epidemiology.
AWARE was a prospective international study of critically ill children (aged 0-25 years) from 32 pediatric intensive care units (ICUs). A subset of AWARE (
= 2451) with known Cr
(gold standard) was used to validate ABC methods using statistical measures of precision (R
) and accuracy (within 10% or 30% of gold standard). The entire cohort (
= 4984) was used to determine how different Cr
estimating equations (3 ABC equations and 4 published estimated glomerular filtration rate [eGFR] equations imputing Cr
) impact AKI incidence and its association with key clinical outcomes, including 28-day mortality, using univariate and multivariate analysis.
The ABC-Age equation (requiring only age) demonstrated similar accuracy and precision compared with existing Cr
equations. The ABC-Creatinine equation (includes age and hospital creatinine value) outperformed existing Cr
equations by up to 15% in precision (ABC-Creatinine, R
= 0.51 vs. full-age spectrum [FAS], R
= 0.36) and 32% in accuracy (ABC-Creatinine, 66% vs. original Schwartz, 34%). For the entire cohort, AKI incidence varied from 7% to 12%, depending on Cr
definition. ABC equations were associated with clinical outcomes similarly to existing Cr
equations.
ABC-Creatinine equation (with minimal variables) outperformed existing Cr
equations for accuracy and precision as the optimal method for Cr
estimation. Cr
definition variability alters AKI incidence and epidemiology, necessitating standardization. Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New equations (the AKI Baseline Creatinine [ABC] methods) for estimating Crb were derived from children without kidney disease. We aimed to externally validate ABC methods in an international cohort and assess how different Crb equations alter AKI epidemiology. AWARE was a prospective international study of critically ill children (aged 0–25 years) from 32 pediatric intensive care units (ICUs). A subset of AWARE (n = 2451) with known Crb (gold standard) was used to validate ABC methods using statistical measures of precision (R2) and accuracy (within 10% or 30% of gold standard). The entire cohort (N = 4984) was used to determine how different Crb estimating equations (3 ABC equations and 4 published estimated glomerular filtration rate [eGFR] equations imputing Crb) impact AKI incidence and its association with key clinical outcomes, including 28-day mortality, using univariate and multivariate analysis. The ABC-Age equation (requiring only age) demonstrated similar accuracy and precision compared with existing Crb equations. The ABC-Creatinine equation (includes age and hospital creatinine value) outperformed existing Crb equations by up to 15% in precision (ABC-Creatinine, R2 = 0.51 vs. full-age spectrum [FAS], R2 = 0.36) and 32% in accuracy (ABC-Creatinine, 66% vs. original Schwartz, 34%). For the entire cohort, AKI incidence varied from 7% to 12%, depending on Crb definition. ABC equations were associated with clinical outcomes similarly to existing Crb equations. ABC-Creatinine equation (with minimal variables) outperformed existing Crb equations for accuracy and precision as the optimal method for Crb estimation. Crb definition variability alters AKI incidence and epidemiology, necessitating standardization. [Display omitted] Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New equations (the AKI Baseline Creatinine [ABC] methods) for estimating Crb were derived from children without kidney disease. We aimed to externally validate ABC methods in an international cohort and assess how different Crb equations alter AKI epidemiology.IntroductionAcute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New equations (the AKI Baseline Creatinine [ABC] methods) for estimating Crb were derived from children without kidney disease. We aimed to externally validate ABC methods in an international cohort and assess how different Crb equations alter AKI epidemiology.AWARE was a prospective international study of critically ill children (aged 0-25 years) from 32 pediatric intensive care units (ICUs). A subset of AWARE (n = 2451) with known Crb (gold standard) was used to validate ABC methods using statistical measures of precision (R2) and accuracy (within 10% or 30% of gold standard). The entire cohort (N = 4984) was used to determine how different Crb estimating equations (3 ABC equations and 4 published estimated glomerular filtration rate [eGFR] equations imputing Crb) impact AKI incidence and its association with key clinical outcomes, including 28-day mortality, using univariate and multivariate analysis.MethodsAWARE was a prospective international study of critically ill children (aged 0-25 years) from 32 pediatric intensive care units (ICUs). A subset of AWARE (n = 2451) with known Crb (gold standard) was used to validate ABC methods using statistical measures of precision (R2) and accuracy (within 10% or 30% of gold standard). The entire cohort (N = 4984) was used to determine how different Crb estimating equations (3 ABC equations and 4 published estimated glomerular filtration rate [eGFR] equations imputing Crb) impact AKI incidence and its association with key clinical outcomes, including 28-day mortality, using univariate and multivariate analysis.The ABC-Age equation (requiring only age) demonstrated similar accuracy and precision compared with existing Crb equations. The ABC-Creatinine equation (includes age and hospital creatinine value) outperformed existing Crb equations by up to 15% in precision (ABC-Creatinine, R2 = 0.51 vs. full-age spectrum [FAS], R2 = 0.36) and 32% in accuracy (ABC-Creatinine, 66% vs. original Schwartz, 34%). For the entire cohort, AKI incidence varied from 7% to 12%, depending on Crb definition. ABC equations were associated with clinical outcomes similarly to existing Crb equations.ResultsThe ABC-Age equation (requiring only age) demonstrated similar accuracy and precision compared with existing Crb equations. The ABC-Creatinine equation (includes age and hospital creatinine value) outperformed existing Crb equations by up to 15% in precision (ABC-Creatinine, R2 = 0.51 vs. full-age spectrum [FAS], R2 = 0.36) and 32% in accuracy (ABC-Creatinine, 66% vs. original Schwartz, 34%). For the entire cohort, AKI incidence varied from 7% to 12%, depending on Crb definition. ABC equations were associated with clinical outcomes similarly to existing Crb equations.ABC-Creatinine equation (with minimal variables) outperformed existing Crb equations for accuracy and precision as the optimal method for Crb estimation. Crb definition variability alters AKI incidence and epidemiology, necessitating standardization.ConclusionABC-Creatinine equation (with minimal variables) outperformed existing Crb equations for accuracy and precision as the optimal method for Crb estimation. Crb definition variability alters AKI incidence and epidemiology, necessitating standardization. Introduction: Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New equations (the AKI Baseline Creatinine [ABC] methods) for estimating Crb were derived from children without kidney disease. We aimed to externally validate ABC methods in an international cohort and assess how different Crb equations alter AKI epidemiology. Methods: AWARE was a prospective international study of critically ill children (aged 0–25 years) from 32 pediatric intensive care units (ICUs). A subset of AWARE (n = 2451) with known Crb (gold standard) was used to validate ABC methods using statistical measures of precision (R2) and accuracy (within 10% or 30% of gold standard). The entire cohort (N = 4984) was used to determine how different Crb estimating equations (3 ABC equations and 4 published estimated glomerular filtration rate [eGFR] equations imputing Crb) impact AKI incidence and its association with key clinical outcomes, including 28-day mortality, using univariate and multivariate analysis. Results: The ABC-Age equation (requiring only age) demonstrated similar accuracy and precision compared with existing Crb equations. The ABC-Creatinine equation (includes age and hospital creatinine value) outperformed existing Crb equations by up to 15% in precision (ABC-Creatinine, R2 = 0.51 vs. full-age spectrum [FAS], R2 = 0.36) and 32% in accuracy (ABC-Creatinine, 66% vs. original Schwartz, 34%). For the entire cohort, AKI incidence varied from 7% to 12%, depending on Crb definition. ABC equations were associated with clinical outcomes similarly to existing Crb equations. Conclusion: ABC-Creatinine equation (with minimal variables) outperformed existing Crb equations for accuracy and precision as the optimal method for Crb estimation. Crb definition variability alters AKI incidence and epidemiology, necessitating standardization. |
| Author | Schwartz, George J. Braun, Chloe Bjornstad, Erica C. Rahman, A.K.M.Fazlur Acharjee, Mithun Kumar Zappitelli, Michael Goldstein, Stuart L. Askenazi, David Basu, Rajit K. |
| Author_xml | – sequence: 1 givenname: Erica C. surname: Bjornstad fullname: Bjornstad, Erica C. email: ebjorns1@uthsc.edu organization: Division of Nephrology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA – sequence: 2 givenname: Mithun Kumar surname: Acharjee fullname: Acharjee, Mithun Kumar organization: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA – sequence: 3 givenname: A.K.M.Fazlur surname: Rahman fullname: Rahman, A.K.M.Fazlur organization: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA – sequence: 4 givenname: Michael surname: Zappitelli fullname: Zappitelli, Michael organization: Department of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada – sequence: 5 givenname: Rajit K. surname: Basu fullname: Basu, Rajit K. organization: Division of Critical Care, Department of Pediatrics, Ann and Robert Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA – sequence: 6 givenname: George J. surname: Schwartz fullname: Schwartz, George J. organization: Division of Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA – sequence: 7 givenname: Stuart L. surname: Goldstein fullname: Goldstein, Stuart L. organization: Division of Nephrology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA – sequence: 8 givenname: Chloe surname: Braun fullname: Braun, Chloe organization: Division of Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA – sequence: 9 givenname: David surname: Askenazi fullname: Askenazi, David organization: Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA |
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| Snippet | Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New equations (the AKI... Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Cr ), unavailable in up to 75% of hospitalized children. New equations (the AKI... Introduction: Acute kidney injury (AKI) definitions rely on known baseline serum creatinine (Crb), unavailable in up to 75% of hospitalized children. New... |
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| Title | Acute Kidney Injury Diagnostic Accuracy and Implications of Different Baseline Creatinine Equations |
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