David Askenazi1, Behtash Saeidi2, Rajesh Koralkar2, Namasivayam Ambalavanan3, Russell L Griffin4. 1. Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave S, Lowder 516, Birmingham, AL, 35233, USA. daskenazi@peds.uab.edu. 2. Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Ave S, Lowder 516, Birmingham, AL, 35233, USA. 3. Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Abstract
BACKGROUND: During the first postnatal weeks, infants have abrupt changes in fluid weight that alter serum creatinine (SCr) concentration, and possibly, the evaluation for acute kidney injury (AKI). METHODS: We performed a prospective study on 122 premature infants to determine how fluid adjustment (FA) to SCr alters the incidence of AKI, demographics, outcomes, and performance of candidate urine biomarkers. FA-SCr values were estimated using changes in total body water (TBW) from birth; FA-SCR = SCr × [TBW + (current wt. - BW)]/ TBW; where TBW = 0.8 × wt in kg). SCr-AKI and FA-SCr AKI were defined if values increased by ≥ 0.3 mg/dl from previous lowest value. RESULTS: AKI incidence was lower using the FA-SCr vs. SCr definition [(23/122 (18.8 %) vs. (34/122 (27.9 %); p < 0.05)], with concordance in 105/122 (86 %) and discordance in 17/122 (14 %). Discordant subjects tended to have similar demographics and outcomes to those who were negative by both definitions. Candidate urine AKI biomarkers performed better under the FA-SCr than SCr definition, especially on day 4 and days 12-14. CONCLUSIONS: Adjusting SCr for acute change in fluid weight may help differentiate SCr rise from true change in renal function from acute concentration due to abrupt weight change.
BACKGROUND: During the first postnatal weeks, infants have abrupt changes in fluid weight that alter serum creatinine (SCr) concentration, and possibly, the evaluation for acute kidney injury (AKI). METHODS: We performed a prospective study on 122 premature infants to determine how fluid adjustment (FA) to SCr alters the incidence of AKI, demographics, outcomes, and performance of candidate urine biomarkers. FA-SCr values were estimated using changes in total body water (TBW) from birth; FA-SCR = SCr × [TBW + (current wt. - BW)]/ TBW; where TBW = 0.8 × wt in kg). SCr-AKI and FA-SCr AKI were defined if values increased by ≥ 0.3 mg/dl from previous lowest value. RESULTS: AKI incidence was lower using the FA-SCr vs. SCr definition [(23/122 (18.8 %) vs. (34/122 (27.9 %); p < 0.05)], with concordance in 105/122 (86 %) and discordance in 17/122 (14 %). Discordant subjects tended to have similar demographics and outcomes to those who were negative by both definitions. Candidate urine AKI biomarkers performed better under the FA-SCr than SCr definition, especially on day 4 and days 12-14. CONCLUSIONS: Adjusting SCr for acute change in fluid weight may help differentiate SCr rise from true change in renal function from acute concentration due to abrupt weight change.
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: Elizabeth J Thompson; Rachel G Greenberg; Karan Kumar; Matthew Laughon; P Brian Smith; Reese H Clark; Andromeda Crowell; Layla Shaw; Louis Harrison; Gabrielle Scales; Nicole Bell; Christoph P Hornik Journal: J Pediatr Date: 2018-05-08 Impact factor: 6.314