Xin Xu1, Sheng Nie2, Aihua Zhang3, Mao Jianhua4, Hai-Peng Liu5, Huimin Xia6, Hong Xu7, Zhangsuo Liu8, Shipin Feng9, Wei Zhou10, Xuemei Liu11, Yonghong Yang12, Yuhong Tao13, Yunlin Feng14, Chunbo Chen15, Mo Wang16, Yan Zha17, Jian-Hua Feng18, Qingchu Li19, Shuwang Ge20, Jianghua Chen21, Yongcheng He22, Siyuan Teng23, Chuanming Hao24, Bi-Cheng Liu25, Ying Tang26, Li-Jun Wang27, Jin-Lei Qi27, Wenjuan He2, Pinghong He2, Youhua Liu2, Fan Fan Hou1. 1. National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; xux007@163.com ffhouguangzhou@163.com. 2. National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China. 3. Division of Nephrology, Children's Hospital of Nanjing Medical University, Nanjing, China. 4. Division of Nephrology, The Children Hospital of Zhejiang University, Hangzhou, China. 5. Anhui Institute of Pediatric Research, Anhui Provincial Children's Hospital, Hefei, China. 6. Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. 7. Division of Nephrology, Children's Hospital of Fudan University, Shanghai, China. 8. Division of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 9. Division of Nephrology, Chengdu Women and Children's Central Hospital, Chengdu, China. 10. Division of Nephrology, Shanghai Children's Medical Center, Shanghai Jiaotong University, Shanghai, China. 11. Division of Nephrology, Jinan Children's Hospital, Jinan, China. 12. Division of Nephrology, Pediatric Medical Research Center, Gansu Province Child's Hospital, Lanzhou University Second Hospital, Lanzhou, China. 13. Division of Nephrology, West China Second University Hospital, Sichuan University, Chengdu, China. 14. Division of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China. 15. Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. 16. Division of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China. 17. Division of Nephrology, Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China. 18. Division of Pediatrics, The Second Affiliated Hospital and. 19. Division of Nephrology, Guilin Medical University Affiliated Hospital, Guilin, China. 20. Division of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 21. Kidney Disease Center, The First Affiliated Hospital, Zhejiang University, Hangzhou, China. 22. Center for Nephrology and Urology Shenzhen University, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China. 23. Division of Nephrology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China. 24. Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China. 25. Institute of Nephrology, Zhong Da Hospital, Nanjing, China. 26. Division of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and. 27. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Abstract
BACKGROUND: Current definitions of AKI do not take into account serum creatinine's high variability in children. METHODS: We analyzed data from 156,075 hospitalized children with at least two creatinine tests within 30 days. We estimated reference change value (RCV) of creatinine on the basis of age and initial creatinine level in children without kidney disease or known AKI risk, and we used these data to develop a model for detecting pediatric AKI on the basis of RCV of creatinine. We defined pediatric AKI according to pediatric reference change value optimized for AKI in children (pROCK) as creatinine increase beyond RCV of creatinine, which was estimated as the greater of 20 μmol/L or 30% of the initial creatinine level. RESULTS: Of 102,817 children with at least two serum creatinine tests within 7 days, 5432 (5.3%) had AKI as defined by pROCK compared with 15,647 (15.2%) and 10,446 (10.2%) as defined by pediatric RIFLE (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO), respectively. Children with pROCK-defined AKI had significantly increased risk of death (hazard ratio, 3.56; 95% confidence interval, 3.15 to 4.04) compared with those without AKI. About 66% of patients with pRIFLE-defined AKI and 51% of patients with KDIGO-defined AKI, mostly children with initial creatinine level of <30 μmol/L, were reclassified as non-AKI by pROCK, and mortality risk in these children was comparable with risk in those without AKI by all definitions. CONCLUSIONS: pROCK criterion improves detection of "true" AKI in children compared with earlier definitions that may lead to pediatric AKI overdiagnosis.
BACKGROUND: Current definitions of AKI do not take into account serum creatinine's high variability in children. METHODS: We analyzed data from 156,075 hospitalized children with at least two creatinine tests within 30 days. We estimated reference change value (RCV) of creatinine on the basis of age and initial creatinine level in children without kidney disease or known AKI risk, and we used these data to develop a model for detecting pediatric AKI on the basis of RCV of creatinine. We defined pediatric AKI according to pediatric reference change value optimized for AKI in children (pROCK) as creatinine increase beyond RCV of creatinine, which was estimated as the greater of 20 μmol/L or 30% of the initial creatinine level. RESULTS: Of 102,817 children with at least two serum creatinine tests within 7 days, 5432 (5.3%) had AKI as defined by pROCK compared with 15,647 (15.2%) and 10,446 (10.2%) as defined by pediatric RIFLE (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO), respectively. Children with pROCK-defined AKI had significantly increased risk of death (hazard ratio, 3.56; 95% confidence interval, 3.15 to 4.04) compared with those without AKI. About 66% of patients with pRIFLE-defined AKI and 51% of patients with KDIGO-defined AKI, mostly children with initial creatinine level of <30 μmol/L, were reclassified as non-AKI by pROCK, and mortality risk in these children was comparable with risk in those without AKI by all definitions. CONCLUSIONS: pROCK criterion improves detection of "true" AKI in children compared with earlier definitions that may lead to pediatric AKI overdiagnosis.
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