Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children

Reliable prediction of severe acute kidney injury (AKI) has the potential to optimize treatment. Here we operationalized the empiric concept of renal angina with a renal angina index (RAI) and determined the predictive performance of RAI. This was assessed on admission to the pediatric intensive car...

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Published in:Kidney international Vol. 85; no. 3; pp. 659 - 667
Main Authors: Basu, Rajit K., Zappitelli, Michael, Brunner, Lori, Wang, Yu, Wong, Hector R., Chawla, Lakhmir S., Wheeler, Derek S., Goldstein, Stuart L.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.03.2014
Elsevier Limited
Subjects:
acute kidney injury
Acute Kidney Injury - diagnosis
biomarkers
Biomarkers - blood
Child
Child, Preschool
Creatinine - blood
Critical Illness
Female
Humans
Infant
Male
pediatrics
renal angina
Severity of Illness Index
renal angina
acute kidney injury
biomarkers
pediatrics
ISSN:0085-2538, 1523-1755, 1523-1755
Online Access:Get full text
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Summary:Reliable prediction of severe acute kidney injury (AKI) has the potential to optimize treatment. Here we operationalized the empiric concept of renal angina with a renal angina index (RAI) and determined the predictive performance of RAI. This was assessed on admission to the pediatric intensive care unit, for subsequent severe AKI (over 200% rise in serum creatinine) 72h later (Day-3 AKI). In a multicenter four cohort appraisal (one derivation and three validation), incidence rates for a Day 0 RAI of 8 or more were 15–68% and Day-3 AKI was 13–21%. In all cohorts, Day-3 AKI rates were higher in patients with an RAI of 8 or more with the area under the curve of RAI for predicting Day-3 AKI of 0.74–0.81. An RAI under 8 had high negative predictive values (92–99%) for Day-3 AKI. RAI outperformed traditional markers of pediatric severity of illness (Pediatric Risk of Mortality-II) and AKI risk factors alone for prediction of Day-3 AKI. Additionally, the RAI outperformed all KDIGO stages for prediction of Day-3 AKI. Thus, we operationalized the renal angina concept by deriving and validating the RAI for prediction of subsequent severe AKI. The RAI provides a clinically feasible and applicable methodology to identify critically ill children at risk of severe AKI lasting beyond functional injury. The RAI may potentially reduce capricious AKI biomarker use by identifying patients in whom further testing would be most beneficial.
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ISSN:0085-2538
1523-1755
1523-1755
DOI:10.1038/ki.2013.349