BACKGROUND AND OBJECTIVES: This study determined if preoperative and postoperative urine albumin/creatinine ratios (ACRs) predict postoperative AKI in children undergoing cardiac surgery (CS). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a three-center, prospective study (2007-2009) of 294 children undergoing CS (n=145 aged <2 years). Urine ACR was measured preoperatively and 0-6 hours after intensive care unit arrival. AKI outcomes were based on the Acute Kidney Injury Network serum creatinine (SCr) criteria (stage 1 AKI, ≥50% or 0.3 mg/dl SCr rise from baseline; and stage 2 or worse AKI, ≥SCr doubling or dialysis). AKI was predicted using preoperative and postoperative ACRs and postoperative ACR performance was compared with other AKI biomarkers. RESULTS: Preoperative ACR did not predict AKI in younger or older children. In children aged <2 years, first postoperative ACR ≥908 mg/g (103 mg/mmol) predicted stage 2 AKI development (adjusted relative risk, 3.4; 95% confidence interval, 1.2-9.4). In children aged ≥2 years, postoperative ACR ≥169 mg/g (19.1 mg/mmol) predicted stage 1 AKI (adjusted relative risk, 2.1; 95% confidence interval, 1.1-4.1). In children aged ≥2 years, first postoperative ACR improved AKI prediction from other biomarker and clinical prediction models, estimated by net reclassification improvement (P≤0.03), but only when serum cystatin C was also included in the model. CONCLUSIONS: Postoperative ACR is a readily available early diagnostic test for AKI after pediatric CS that performs similarly to other AKI biomarkers; however, its use is enhanced in children aged ≥2 years and in combination with serum cystatin C.
BACKGROUND AND OBJECTIVES: This study determined if preoperative and postoperative urine albumin/creatinine ratios (ACRs) predict postoperative AKI in children undergoing cardiac surgery (CS). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a three-center, prospective study (2007-2009) of 294 children undergoing CS (n=145 aged <2 years). Urine ACR was measured preoperatively and 0-6 hours after intensive care unit arrival. AKI outcomes were based on the Acute Kidney Injury Network serum creatinine (SCr) criteria (stage 1 AKI, ≥50% or 0.3 mg/dl SCr rise from baseline; and stage 2 or worse AKI, ≥SCr doubling or dialysis). AKI was predicted using preoperative and postoperative ACRs and postoperative ACR performance was compared with other AKI biomarkers. RESULTS: Preoperative ACR did not predict AKI in younger or older children. In children aged <2 years, first postoperative ACR ≥908 mg/g (103 mg/mmol) predicted stage 2 AKI development (adjusted relative risk, 3.4; 95% confidence interval, 1.2-9.4). In children aged ≥2 years, postoperative ACR ≥169 mg/g (19.1 mg/mmol) predicted stage 1 AKI (adjusted relative risk, 2.1; 95% confidence interval, 1.1-4.1). In children aged ≥2 years, first postoperative ACR improved AKI prediction from other biomarker and clinical prediction models, estimated by net reclassification improvement (P≤0.03), but only when serum cystatin C was also included in the model. CONCLUSIONS: Postoperative ACR is a readily available early diagnostic test for AKI after pediatric CS that performs similarly to other AKI biomarkers; however, its use is enhanced in children aged ≥2 years and in combination with serum cystatin C.
Authors: Camille A Jones; Mildred E Francis; Mark S Eberhardt; Blanche Chavers; Josef Coresh; Michael Engelgau; John W Kusek; Danita Byrd-Holt; K M Venkat Narayan; William H Herman; Camara P Jones; Marcel Salive; Lawrence Y Agodoa Journal: Am J Kidney Dis Date: 2002-03 Impact factor: 8.860
Authors: M Sanchez-Bayle; C Rodriguez-Cimadevilla; C Asensio; C Ruiz-Jarabo; J Baena; P Arnaiz; S Villa; P Cocho Journal: Pediatr Nephrol Date: 1995-08 Impact factor: 3.714
Authors: A Akcan-Arikan; M Zappitelli; L L Loftis; K K Washburn; L S Jefferson; S L Goldstein Journal: Kidney Int Date: 2007-03-28 Impact factor: 10.612
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097
Authors: Christina A de Fontnouvelle; Jason H Greenberg; Heather R Thiessen-Philbrook; Michael Zappitelli; Jeremy Roth; Kathleen F Kerr; Prasad Devarajan; Michael Shlipak; Steven Coca; Chirag R Parikh Journal: Ann Thorac Surg Date: 2017-08-16 Impact factor: 4.330
Authors: Michael Zappitelli; Chirag R Parikh; James S Kaufman; Alan S Go; Paul L Kimmel; Chi-Yuan Hsu; Steven G Coca; Vernon M Chinchilli; Jason H Greenberg; Marva M Moxey-Mims; T Alp Ikizler; Vedran Cockovski; Anne-Marie Dyer; Prasad Devarajan Journal: Clin J Am Soc Nephrol Date: 2020-09-18 Impact factor: 8.237