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Kidney Week

Abstract: TH-PO067

Using Kinetic eGFR to Predict AKI in Pediatric Intensive Care Unit

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Menon, Shina, Seattle Children's Hospital, Seattle, Washington, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio, United States
  • Basu, Rajit K., Children's Healthcare of Atlanta, Atlanta, Georgia, United States
Background

Acute kidney injury (AKI) is common in intensive care unit (ICU). The ability to distinguish between functional and persistent AKI is important. Creatinine (Cr), commonly used for diagnosis is imperfect; combining it with urinary biomarkers may help differentiate the two. Kinetic estimated GFR (keGFR) has been used to predict AKI and likelihood of renal recovery. It uses creatinine values at two time points for a dynamic assessment of renal function. It can improve understanding of AKI trajectory and has been used to predict AKI. There are limited data on its use in pediatrics. We hypothesized keGFR would improve clinical and prognostic information beyond Cr or eGFR (modified Schwartz GFR)

Methods

We performed secondary analysis of data from Acute Kidney Injury in Children Expected by Renal angina and Urinary Biomarkers (AKI-CHERUB), a prospective, observational study of children 3months- 25 years age admitted to ICU. For this analyses, only those with complete data upto day 3 were analyzed. keGFR was calculated on Days 1-3. Functional AKI (fAKI) was defined as return to baseline Cr by Day 3 and persistent AKI (pAKI) was absence of recovery by Day 3. Primary outcome was pAKI and secondary outcomes were AKI stage 2/3 during the first 7 days and fAKI

Results

169 patients were analyzed (50% female). AKI at admission was seen in 40 (23.6%). Of those, 23 had fAKI and 13 had pAKI. keGFR pattern was similar to that of eGFR (Fig 1) for both groups. Of those who did not have AKI at admission, 17 developed stage 2/3 AKI during the first 7 days in PICU. Median keGFR for these patients was 85.5 mL/min/1.73 m2 compared to eGFR of 79.5 mL/min/1.73m2

Conclusion

AKI diagnosis is mostly dependent on a rise in Cr which is an imperfect and late marker. The key to improving outcomes in AKI is early prediction of Cr trajectory and appropriate intervention. Although keGFR has been used in adults for this purpose, our analysis shows that it may not be ready for use in pediatrics. It can be used in conjunction with eGFR to identify AKI patterns but it is not superior to eGFR