Using kinetic eGFR to identify acute kidney injury risk in children undergoing cardiac transplantation.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
17
06
2020
accepted:
18
11
2020
revised:
12
10
2020
pubmed:
16
1
2021
medline:
18
3
2022
entrez:
15
1
2021
Statut:
ppublish
Résumé
Acute kidney injury (AKI) is common following pediatric cardiac transplantation. Since no treatments exist, strategies focus on early identification and prevention. Kinetic glomerular filtration rate (kGFR) was developed to assess renal function in the non-steady state. Although used to predict AKI in adults, kGFR has not been explored in children. Our study examines AKI and the ability of kGFR to identify AKI risk in pediatric heart transplant recipients. One hundred and seventy-five patients under 21 years who underwent cardiac transplantation at Lucile Packard Children's Hospital between September 2007-December 2017 were included. kGFR One hundred and thirty-one (75%) and 78 (45%) patients developed AKI and severe AKI, respectively; 5 (2.9%) required dialysis. kGFR was moderately associated with post-operative AKI risk. The adjusted area under the curve (AUC) for kGFR AKI is pervasive in children undergoing cardiac transplant, particularly in the 24 h after surgery. kGFR moderately identifies AKI risk and may represent a novel risk stratification technique. Our research suggests that kGFR, a dynamic assessment of renal function that uses readily available laboratory values, can moderately identify AKI risk in children undergoing cardiac transplantation. Current published studies on kGFR are in adult populations; this study represents the first formal study of kGFR in a pediatric population. kGFR may serve as an early AKI indicator, allowing providers to implement preventative strategies sooner in a patient's clinical course.
Sections du résumé
BACKGROUND
Acute kidney injury (AKI) is common following pediatric cardiac transplantation. Since no treatments exist, strategies focus on early identification and prevention. Kinetic glomerular filtration rate (kGFR) was developed to assess renal function in the non-steady state. Although used to predict AKI in adults, kGFR has not been explored in children. Our study examines AKI and the ability of kGFR to identify AKI risk in pediatric heart transplant recipients.
METHODS
One hundred and seventy-five patients under 21 years who underwent cardiac transplantation at Lucile Packard Children's Hospital between September 2007-December 2017 were included. kGFR
RESULTS
One hundred and thirty-one (75%) and 78 (45%) patients developed AKI and severe AKI, respectively; 5 (2.9%) required dialysis. kGFR was moderately associated with post-operative AKI risk. The adjusted area under the curve (AUC) for kGFR
CONCLUSIONS
AKI is pervasive in children undergoing cardiac transplant, particularly in the 24 h after surgery. kGFR moderately identifies AKI risk and may represent a novel risk stratification technique.
IMPACT
Our research suggests that kGFR, a dynamic assessment of renal function that uses readily available laboratory values, can moderately identify AKI risk in children undergoing cardiac transplantation. Current published studies on kGFR are in adult populations; this study represents the first formal study of kGFR in a pediatric population. kGFR may serve as an early AKI indicator, allowing providers to implement preventative strategies sooner in a patient's clinical course.
Identifiants
pubmed: 33446916
doi: 10.1038/s41390-020-01307-3
pii: 10.1038/s41390-020-01307-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
632-636Informations de copyright
© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
Références
Toda, Y. & Sugimoto, K. AKI after pediatric cardiac surgery for congenital heart diseases-recent developments in diagnostic criteria and early diagnosis by biomarkers. J. Intens. Care 5, 49 (2017).
doi: 10.1186/s40560-017-0242-z
Li, S. et al. TRIBE-AKI Consortium. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit. Care Med. 39, 1493–1499 (2011).
doi: 10.1097/CCM.0b013e31821201d3
MacDonald, C. et al. Western Canadian Complex Pediatric Therapies Follow-Up Group. Acute kidney injury after heart transplant in young children: risk factors and outcomes. Pediatr. Nephrol. 31, 671–678 (2016).
doi: 10.1007/s00467-015-3252-x
Hollander, S. A. et al. Recovery from acute kidney injury and CKD following heart transplantation in children, adolescents, and young adults: a retrospective cohort study. Am. J. Kidney Dis. 68, 212–218 (2016).
doi: 10.1053/j.ajkd.2016.01.024
Greenberg, J. H. & Parikh, C. R. Biomarkers for diagnosis and prognosis of AKI in children: one size does not fit all. Clin. J. Am. Soc. Nephrol. 12, 1551–1557 (2017).
doi: 10.2215/CJN.12851216
Chen, S. Retooling the creatinine clearance equation to estimate kinetic GFR when the plasma creatinine is changing acutely. J. Am. Soc. Nephrol. 24, 877–888 (2013).
doi: 10.1681/ASN.2012070653
Mian, A. N. & Schwartz, G. J. Measurement and estimation of glomerular filtration rate in children. Adv. Chronic Kidney Dis. 24, 348–356 (2017).
doi: 10.1053/j.ackd.2017.09.011
Palevsky, P. M. et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am. J. Kidney Dis. 61, 649–72. (2013).
doi: 10.1053/j.ajkd.2013.02.349
Harrell, F. E. Jr. Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis (Springer, 2015).
R Core Team. R: A Language and Environment for Statistical Computing (R Foundation for Statistical Computing, Vienna, 2018).
Harrell F. E. Jr. RMS: regression modeling strategies. R package version 51-2. https://CRAN.R-project.org/package=rms (2018).
Greenberg, J. H. et al. Biomarkers of AKI progression after pediatric cardiac surgery. J. Am. Soc. Nephrol. 29, 1549–1556 (2018).
doi: 10.1681/ASN.2017090989
Zappitelli, M. et al. Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) Consortium. Association of definition of acute kidney injury by cystatin C rise with biomarkers and clinical outcomes in children undergoing cardiac surgery. JAMA Pediatr. 169, 583–591 (2015).
doi: 10.1001/jamapediatrics.2015.54
Filho, L. T., Grande, A. J., Colonetti, T., Della, É. S. P. & da Rosa, M. I. Accuracy of neutrophil gelatinase-associated lipocalin for acute kidney injury diagnosis in children: systematic review and meta-analysis. Pediatr. Nephrol. 32, 1979–1988 (2017).
doi: 10.1007/s00467-017-3704-6
de Fontnouvelle, C. A. et al. TRIBE-AKI Consortium. Interleukin-8 and tumor necrosis factor predict acute kidney injury after pediatric cardiac surgery. Ann. Thorac. Surg. 104, 2072–2079 (2017).
doi: 10.1016/j.athoracsur.2017.04.038
Meersch, M. et al. Validation of cell-cycle arrest biomarkers for acute kidney injury after pediatric cardiac surgery. PLoS ONE 9, e110865 (2014).
doi: 10.1371/journal.pone.0110865
Pianta, T. J., Endre, Z. H., Pickering, J. W., Buckley, N. A. & Peake, P. W. Kinetic estimation of GFR improves prediction of dialysis and recovery after kidney transplantation. PLoS ONE 10, e0125669 (2015).
doi: 10.1371/journal.pone.0125669
Endre, Z. H., Pianta, T. J. & Pickering, J. W. Timely diagnosis of acute kidney injury using kinetic eGFR and the creatinine excretion to production ratio, E/eG—creatinine can be useful! Nephron 132, 312–316 (2016).
doi: 10.1159/000444456
Hekmat, R., Eshraghi, H., Esmailpour, M. & Hassankhani, G. G. Kinetic glomerular filtration rate estimation compared with other formulas for evaluating acute kidney injury stage early after kidney donation. Exp. Clin. Transplant. 15, 104–109 (2017).
pubmed: 28260446
O’Sullivan, E. D. & Doyle, A. The clinical utility of kinetic glomerular filtration rate. Clin. Kidney J. 10, 202–208 (2017).
pubmed: 28396736
Seelhammer, T. G. et al. Kinetic estimated glomerular filtration rate and acute kidney injury in cardiac surgery patients. J. Crit. Care 31, 249–254 (2016).
doi: 10.1016/j.jcrc.2015.11.006
Macedo, E. Urine output assessment as a clinical quality measure. Nephron 131, 252–254 (2015).
doi: 10.1159/000437312
Bairy, M., See, F. H. W. & Lim, R. S. Using the kinetic estimating glomerular filtration rate equation for estimating glomerular filtration rate and detecting acute kidney injury: a pilot study. Nephron 140, 231–239 (2018).
doi: 10.1159/000492439
de Oliveira Marques, F. et al. Kinetic estimated glomerular filtration rate in critically ill patients: beyond the acute kidney injury severity classification system. Crit. Care. 21, 280 (2017).
doi: 10.1186/s13054-017-1873-0