Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
28
06
2018
accepted:
24
11
2018
revised:
06
11
2018
pubmed:
16
1
2019
medline:
9
6
2020
entrez:
16
1
2019
Statut:
ppublish
Résumé
Neonates with serum creatinine (SCr) rise ≥0.3 mg/dL and/or ≥50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds. Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1-2 and ≥1 SCr on postnatal days 3-8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups. The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 and ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity. Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.
Sections du résumé
BACKGROUND
Neonates with serum creatinine (SCr) rise ≥0.3 mg/dL and/or ≥50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds.
METHODS
Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1-2 and ≥1 SCr on postnatal days 3-8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups.
RESULTS
The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 and ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity.
CONCLUSION
Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.
Identifiants
pubmed: 30643188
doi: 10.1038/s41390-018-0249-8
pii: 10.1038/s41390-018-0249-8
pmc: PMC6377843
mid: NIHMS1515823
doi:
Substances chimiques
Biomarkers
0
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
329-338Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR003096
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001449
Pays : United States
Organisme : NCATS NIH HHS
ID : U54 TR001356
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001417
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK103608
Pays : United States
Organisme : FDA HHS
ID : R01 FD005092
Pays : United States
Organisme : NCRR NIH HHS
ID : KL2 RR025776
Pays : United States
Investigateurs
David T Selewski
(DT)
Subrata Sarkar
(S)
Alison Kent
(A)
Jeffery Fletcher
(J)
Shahnaz Duara
(S)
Jennifer R Charlton
(JR)
Jonathan R Swanson
(JR)
Ronnie Guillet
(R)
Carl D'Angio
(C)
Ayesa Mian
(A)
Deepak Kumar
(D)
Jennifer G Jetton
(JG)
Patrick D Brophy
(PD)
Tarah T Colaizy
(TT)
Jonathan M Klein
(JM)
Ayse Akcan Arikan
(AA)
Christopher J Rhee
(CJ)
Stuart L Goldstein
(SL)
Amy T Nathan
(AT)
Juan C Kupferman
(JC)
Alok Bhutada
(A)
Shantanu Rastogi
(S)
Elizabeth Bonachea
(E)
John Mahan
(J)
Alexandra Smith
(A)
Mamta Fuloria
(M)
Kimberly Reidy
(K)
Frederick J Kaskel
(FJ)
Danielle E Soranno
(DE)
Jason Gien
(J)
Katja M Gist
(KM)
Aftab S Chishti
(AS)
Mina H Hanna
(MH)
Sangeeta Hingorani
(S)
Michelle Starr
(M)
Sunny Juul
(S)
Craig S Wong
(CS)
Catherine Joseph
(C)
Tara DuPont
(T)
Robin Ohls
(R)
Amy Staples
(A)
Surender Khokhar
(S)
Mary Revenis
(M)
Sidharth K Sethi
(SK)
Smriri Rohatgi
(S)
Cherry Mammen
(C)
Anne Synnes
(A)
Sanjay Wazir
(S)
Pia Wintermark
(P)
Robert Woroniecki
(R)
Shanty Sridhar
(S)
Susan Ingraham
(S)
Arwa Nada
(A)
Références
Wong, J. H. et al. Severe acute kidney injury following stage 1 Norwood palliation: effect on outcomes and risk of severe acute kidney injury at subsequent surgical stages. Pediatr. Crit. Care. Med. 17, 615–623 (2016).
doi: 10.1097/PCC.0000000000000734
Taylor, M. L. et al. Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J. Thorac. Cardiovasc. Surg. 146, 146–152 (2013).
doi: 10.1016/j.jtcvs.2012.09.008
dos Santos El Halal, M. G. & Carvalho, P. R. Acute kidney injury according to pediatric RIFLE criteria is associated with negative outcomes after heart surgery in children. Pediatr. Nephrol. 28, 1307–1314 (2013).
doi: 10.1007/s00467-013-2495-7
Aydin, S. I. et al. Acute kidney injury after surgery for congenital heart disease. Ann. Thorac. Surg. 94, 1589–1595 (2012).
doi: 10.1016/j.athoracsur.2012.06.050
Mathur, N. B., Agarwal, H. S. & Maria, A. Acute renal failure in neonatal sepsis. Indian J. Pediatr. 73, 499–502 (2006).
doi: 10.1007/BF02759894
Sarkar, S. et al. Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia. Pediatr. Res. 75, 431–435 (2014).
doi: 10.1038/pr.2013.230
Alaro, D., Bashir, A., Musoke, R. & Wanaiana, L. Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia. Afr. Health Sci. 14, 682–688 (2014).
doi: 10.4314/ahs.v14i3.26
Selewski, D. T., Jordan, B. K., Askenazi, D. J., Dechert, R. E. & Sarkar, S. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J. Pediatr. 162, 725–729 e721 (2013).
doi: 10.1016/j.jpeds.2012.10.002
Askenazi, D. J. et al. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr. Nephrol. 28, 661–666 (2013).
doi: 10.1007/s00467-012-2369-4
Fleming, G. M. et al. The incidence of acute kidney injury and its effect on neonatal and pediatric extracorporeal membrane oxygenation outcomes: a multicenter report from the kidney intervention during extracorporeal membrane oxygenation study group. Pediatr. Crit. Care. Med. 17, 1157–1169 (2016).
doi: 10.1097/PCC.0000000000000970
Gadepalli, S. K., Selewski, D. T., Drongowski, R. A. & Mychaliska, G. B. Acute kidney injury in congenital diaphragmatic hernia requiring extracorporeal life support: an insidious problem. J. Pediatr. Surg. 46, 630–635 (2011).
doi: 10.1016/j.jpedsurg.2010.11.031
Askenazi, D. J. et al. Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation. Pediatr. Crit. Care. Med. 12, e1–e6 (2011).
doi: 10.1097/PCC.0b013e3181d8e348
Askenazi, D. J., Griffin, R., McGwin, G., Carlo, W. & Ambalavanan, N. Acute kidney injury is independently associated with mortality in very low birthweight infants: a matched case-control analysis. Pediatr. Nephrol. 24, 991–997 (2009).
doi: 10.1007/s00467-009-1133-x
Carmody, J. B., Swanson, J. R., Rhone, E. T. & Charlton, J. R. Recognition and reporting of AKI in very low birth weight infants. Clin. J. Am. Soc. Nephrol. 9, 2036–2043 (2014).
doi: 10.2215/CJN.05190514
Daga, A., Dapaah-Siakwan, F., Rajbhandari, S., Arevalo, C. & Salvador, A. Diagnosis and risk factors of acute kidney injury in very low birth weight infants. Pediatr. Neonatol. 58, 258–263 (2017).
doi: 10.1016/j.pedneo.2016.08.002
Koralkar, R. et al. Acute kidney injury reduces survival in very low birth weight infants. Pediatr. Res. 69, 354–358 (2011).
doi: 10.1203/PDR.0b013e31820b95ca
Nagaraj, N., Berwal, P. K., Srinivas, A. & Berwal, A. A study of acute kidney injury in hospitalized preterm neonates in NICU. J. Neonatal Perinat. Med 9, 417–421 (2016).
doi: 10.3233/NPM-161614
Stojanovic, V., Barisic, N., Milanovic, B. & Doronjski, A. Acute kidney injury in preterm infants admitted to a neonatal intensive care unit. Pediatr. Nephrol. 29, 2213–2220 (2014).
doi: 10.1007/s00467-014-2837-0
Viswanathan, S., Manyam, B., Azhibekov, T. & Mhanna, M. J. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr. Nephrol. 27, 303–311 (2012).
doi: 10.1007/s00467-011-1977-8
Jetton, J. G. et al. Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: design of a retrospective cohort study. Front. Pediatr. 4, 68 (2016).
doi: 10.3389/fped.2016.00068
Jetton, J. G. et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet.: Child Adolesc. Health 1, 184–194 (2017).
Zappitelli, M. et al. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr. Res. 82, 569–573 (2017).
doi: 10.1038/pr.2017.136
DeLong, E. R., DeLong, D. M. & Clarke-Pearson, D. L. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44, 837–845 (1988).
doi: 10.2307/2531595
Trajman, A. & Luiz, R. R. McNemar chi2 test revisited: comparing sensitivity and specificity of diagnostic examinations. Scand. J. Clin. Lab. Invest. 68, 77–80 (2008).
doi: 10.1080/00365510701666031
Kellum, J. A., . & Lameire, N. KDIGO AKI Guideline Work Group Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1).Crit. Care 17, 204 (2013).
doi: 10.1186/cc11454
Askenazi, D. J., Ambalavanan, N. & Goldstein, S. L. Acute kidney injury in critically ill newborns: what do we know? What do we need to learn? Pediatr. Nephrol. 24, 265–274 (2009).
doi: 10.1007/s00467-008-1060-2
Gupta, C., Massaro, A. N. & Ray, P. E. A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy. Pediatr. Nephrol. 31, 1167–1178 (2016).
doi: 10.1007/s00467-016-3317-5
Askenazi, D., Saeidi, B., Koralkar, R., Ambalavanan, N. & Griffin, R. L. Acute changes in fluid status affect the incidence, associative clinical outcomes, and urine biomarker performance in premature infants with acute kidney injury. Pediatr. Nephrol. 31, 843–851 (2016).
doi: 10.1007/s00467-015-3258-4