A Comparison of the Systems for the Identification of Postoperative Acute Kidney Injury in Pediatric Cardiac Patients

Lex, Dániel J.; Tóth, Roland; Cserép, Zsuzsanna; Alexander, Stephen I.; Breuer, Tamás; Sápi, Erzsébet; Szatmári, András; Székely, E; Gál, János; Székely, Andrea

doi:10.1016/j.athoracsur.2013.09.014

Cited by 112 publications

(98 citation statements)

References 22 publications

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“…They found that RIFLE and KDIGO resulted in identical incidences but that AKIN led to a lower incidence; additionally, RIFLE and KDIGO demonstrated better mortality discrimination than did AKIN. Lex et al examined the pRIFLE, AKIN, and KDIGO definitions in children undergoing corrective cardiac surgery (25). They too found that as each of the three definitions was applied, patients transitioned between AKI stages; furthermore, the AKI cohorts defined by each set of criteria experienced different mortality.…”

Section: Discussionmentioning

confidence: 99%

AKI in Hospitalized Children

Sutherland

Byrnes

Kothari

et al. 2015

Clinical Journal of the American Society of Nephrology

387

254

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Background and objectives Although several standardized definitions for AKI have been developed, no consensus exists regarding which to use in children. This study applied the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria to an anonymized cohort of hospitalizations extracted from the electronic medical record to compare AKI incidence and outcomes in intensive care unit (ICU) and non-ICU pediatric populations.Design, setting, participants, & measurements Observational, electronic medical record-enabled study of 14,795 hospitalizations at the Lucile Packard Children's Hospital between 2006 and 2010. AKI and AKI severity stage were defined by the pRIFLE, AKIN, and KDIGO definitions according to creatinine change criteria; urine output criteria were not used. The incidences of AKI and each AKI stage were calculated for each classification system. All-cause, in-hospital mortality and total hospital length of stay (LOS) were compared at each subsequent AKI stage by Fisher exact and Kolmogorov-Smirnov tests, respectively.Results AKI incidences across the cohort according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. Mortality was higher among patients with AKI across all definitions (pRIFLE, 2.3%; AKIN, 2.7%; KDIGO, 2.5%; P,0.001 versus no AKI [0.8%-1.0%]). Within the ICU, pRIFLE, AKIN, and KDIGO demonstrated progressively higher mortality at each AKI severity stage; AKI was not associated with mortality outside the ICU by any definition. Both in and outside the ICU, AKI was associated with significantly higher LOS at each AKI severity stage across all three definitions (P,0.001). Definitions resulted in differences in diagnosis and staging of AKI; staging agreement ranged from 76.7% to 92.5%.Conclusions Application of the three definitions led to differences in AKI incidence and staging. AKI was associated with greater mortality and LOS in the ICU and greater LOS outside the ICU. All three definitions demonstrated excellent interstage discrimination. While each definition offers advantages, these results underscore the need to adopt a single, universal AKI definition.

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Section: Discussionmentioning

confidence: 99%

AKI in Hospitalized Children

Sutherland

Byrnes

Kothari

et al. 2015

Clinical Journal of the American Society of Nephrology

387

254

View full text Add to dashboard Cite

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“…All the three classifications showed AKI deterioration which was related to mortality [51]. The AKIN classification however correlated better with mortality than the RIFLE criteria did [52].…”

Section: Other Miscellaneous Predictors and Prognostic Indicators Of Akimentioning

confidence: 99%

Pediatric acute kidney injury: Appraisal of predictors and prognostic indicators

Uwaezuoke

2016

JAD

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“…The eGFR-based pRIFLE classification appears to be more sensitive in detecting mild functional impairment than the AKIN or KDIGO criteria [18][19][20]. In the study of Lex et al [19], a significant number of patients were identified by pRIFLE criteria but missed by the AKIN criteria, while 5 % of children who were missed by the adult definitions of both the KDIGO and AKIN guidelines were identified using the pRIFLE classification.…”

Section: Introductionmentioning

confidence: 97%

“…In the study of Lex et al [19], a significant number of patients were identified by pRIFLE criteria but missed by the AKIN criteria, while 5 % of children who were missed by the adult definitions of both the KDIGO and AKIN guidelines were identified using the pRIFLE classification. Several studies have assessed the prognostic value of these classification systems (in terms of length of hospital stay, costs, morbidity, and mortality) for pediatric patients [21].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of acute kidney injury in children worldwide, including developing countries

2016

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In this review we summarize the world-wide epidemiology of acute kidney injury (AKI) in children with special emphasis on low-income countries, notably those of the sub-Saharan continent. We discuss definitions and classification systems used in pediatric AKI literature. At present, despite some shortcomings, traditional Pediatric Risk Injury Failure Loss and End Stage Kidney Disease (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) systems are the most clinically useful. Alternative definitions, such as monitoring serum cystatin or novel urinary biomarkers, including cell cycle inhibitors, require more long-term studies in heterogenous pediatric AKI populations before they can be recommended in routine clinical practice. A potentially interesting future application of some novel biomarkers could be incorporation into the "renal angina index", a concept recently introduced in pediatric nephrology. The most reliable epidemiological data on AKI in children come from high-outcome countries and are frequently focused on critically ill pediatric intensive care unit populations. In these patients AKI is often secondary to other systemic illnesses or their treatment. Based on a recent literature search performed within the framework of the "AKI 0by25" project of the International Society of Nephrology, we discuss the scarce and often inaccurate data on AKI epidemiology in low-income countries, notably those on the African continent. The last section reflects on some of the many barriers to improvement of overall health care in low-income populations. Although preventive strategies for AKI in low-income countries should essentially be the same as those in high-income countries, we believe any intervention for earlier detection and better treatment of AKI must address all health determinants, including educational, cultural, socio-economic and environmental factors, specific for these deprived areas.

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A Comparison of the Systems for the Identification of Postoperative Acute Kidney Injury in Pediatric Cardiac Patients

Cited by 112 publications

References 22 publications

AKI in Hospitalized Children

AKI in Hospitalized Children

Pediatric acute kidney injury: Appraisal of predictors and prognostic indicators

Epidemiology of acute kidney injury in children worldwide, including developing countries

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