Abstract: FR-PO065

Assessment of the Renal Angina Index for Prediction of Severe AKI Prediction in Critically Ill Children

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Basu, Rajit K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Kaddourah, Ahmad, None, Doha, Qatar
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Acute kidney injury (AKI) occurs in one in four children admitted to the intensive care unit (ICU) and escalating AKI severity is independently associated with increased risk of patient morbidity and mortality. Early prediction of AKI has the potential to improve outcomes.

Methods

We conducted a multi-national, multi-center, prospective study of children admitted to the intensive care unit (ICU) between January-December 2014 with an expected length of stay > 48 hours (NCT01987921) . Our primary aim was to assess the performance of fulfillment of renal angina (RA+), a context-driven risk stratification system, on the day of ICU admission (Day0) for prediction of severe AKI occurrence 3 days after ICU admission (Day3). The primary outcome was the performance of renal angina for prediction of severe AKI three days after ICU admission (Day3-severe AKI) by Stage 2-3 AKI KDIGO AKI guidelines. Renal angina was determined at 12 hours into Day0 using the renal angina index (RAI); RA+ was defined as a RAI > 8. The predictive performance of the Day0-RAI was compared to changes in serum creatinine (SCr) (measured in the first 12 hours of ICU admission) relative to baseline (Day0-SCr/Base).

Results

1590 patients studied were 55% male and median age of 54.5 months. 286 patients (17.9%) were Day0-RA+, 121 (42.3%) of whom developed Day3-severe AKI (versus 247 (18.9%) of Day0-RA- patients, relative risk (RR) 2.23; 95% confidence interval (CI): 1.87-2.66, p<0.001). Patients with Day3-severe AKI (368, 23.1%) had increased utilization of renal replacement therapy (10.9% vs. 1.5%, p<0.001), and higher rate of Day28 mortality (7.6% vs. 4.3%, p=0.01) versus patients without Day3-severe AKI. Day0-RA+ demonstrated superior prediction for Day3-severe AKI than SCr>Base (RR: 1.61; (1.33-1.93), p<0.001) and maintained this superiority with Day3-severe AKI on multivariate regression (independent odds ratio (OR): RA+ 3.21; 95% CI (2.20-4.67) vs. SCr>Base 0.68; 95% CI (0.49-4.94)).

Conclusion

Compared to isolated context-free changes in SCr, the RAI demonstrates improved accuracy for prediction of severe AKI in critically ill children and young adults. Earlier, more accurate prediction of severe AKI has the potential to improve AKI associated patient outcomes.