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Abstract: TH-PO060

Comparison of Diagnostic Criteria for AKI in Critically Ill Children: A Multicenter Cohort Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Kuai, Yuxian, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
  • Huang, Hui, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
  • Li, Yanhong, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
Background

Substantial interstudy heterogeneity exists in defining acute kidney injury (AKI) and baseline serum creatinine (SCr). This study assessed AKI incidence and its association with pediatric intensive care unit (PICU) mortality under different AKI and baseline SCr definitions to determine the preferable approach for diagnosing pediatric AKI.

Methods

This multicenter prospective cohort study was conducted in the PICUs of four tertiary hospitals in China. AKI was defined and staged according to the definitions of the KDIGO, modified KDIGO (SCr increase should reach a concentration of at least 0.5 mg/dL when the KDIGO criterion with SCr is applied to define AKI), and the pROCK (pediatric reference change value optimized for AKI: SCr rise ≥0.2 mg/dL and ≥1.3 times the baseline SCr within 7 days). The baseline SCr was calculated based on the Schwartz formula or estimated as the upper normative value (NormsMax), admission SCr (AdmSCr) and modified AdmSCr. The impacts of different AKI definitions and baseline SCr estimation methods on AKI incidence, severity distribution and AKI outcome were evaluated.

Results

Different AKI definitions and baseline SCr estimates led to differences in AKI incidence, from 6.8% to 25.7%; patients with AKI across all definitions had higher PICU mortality ranged from 19.0% to 35.4%. A higher AKI incidence (25.7%) but lower mortality (19.0%) was observed based on the Schwartz according to the KDIGO, which however was overcome by modified KDIGO (AKI incidence: 16.3%, PICU mortality: 26.1%). For the modified KDIGO, the consistencies of AKI stages between different baseline SCr estimation methods were all strong with the concordance rates >90.0% and weighted kappa values >0.8, and PICU mortality increased pursuant to staging based on the Schwartz. For the pROCK, PICU mortality did not increase pursuant to staging and AKI stage 3 was not associated with mortality after adjustment for confounders.

Conclusion

The AKI incidence and staging vary depending on the definition and baseline SCr estimation method used. The KDIGO definition is sensitive, identifying a great number of mild AKI. The modified KDIGO based on the Schwartz method is more strongly associated with related mortality and may be the preferable approach for the diagnosis of pediatric AKI, which shows promise for improving clinicians’ ability to diagnose AKI in children.