Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study

Basu, Rajit K.; Kaddourah, Ahmad; Akcan-Arikan, Ayse; Arnold, Megan; Cruz, C.; Goldsworthy, Michele; Jaimon, Nancy; Alexander, Stephen I.; Festa, Marino S.; Hahn, Deirdré; Brown, Lauren; Jeon, Ari; Deep, Akash; Askenazi, David; Bagshaw, Sean M.; Morgan, Catherine; Alobaidi, Rashid; Cooper, David S.; Goldstein, Stuart L.; Mottes, Theresa; Terrell, Tara; Arnold, P; Metcalf, Christina M.; Woodley, Shalayna; Bogdanović, Radovan; Stajić, Nataša; Kovačevíc, Branko; Peco-Antić, Amira; Paripović, Aleksandra; Brophy, Patrick D.; Bunchman, Timothy E.; Williams, D. Pauline; Hoot, Michelle R.; Chadha, Vimal; Davis, Keefe; Dharnidharka, Vikas R.; Walther, Leslie; Faustino, E. Vincent S.; Taft, Janet; Tala, Joana; Gist, Katja M.; Soranno, Danielle E.; Ha, Il Soo; Kang, Hee Gyung; Hackbarth, Richard; Avendt-Reeber, Mary; Butler, Chloe; DeGraaf, Doug; Eding, Dawn; Hautala, Nathalie; Ndika, Akunne; Hidayati, Eka Laksmi; Huang, Songming; Kennedy, Seán; Didsbury, Madeleine; Kushartono, Hari; Prasetyo, Risky Vitria; Mammen, Cherry; Paden, Matthew L.; Stone, Cheryl; Picca, Stefano; Connola, Federica; Schneider, James; Sweberg, Todd; Kessel, Aaron; Selewski, David T.; Hieber, Susan; Spasojević-Dimitrijeva, Brankica; Ivanisevic, Ivana; Putnik, Jovana; Ristic, Snezana; Sutherland, Scott M.; Staples, Amy; Wong, Craig S.; Hadid, Senan; Joseph, Catherine; Woroniecki, Robert P.; Zappitelli, Michael; Elsaerafy, Noha; Zaritsky, Joshua J.

doi:10.1016/s2352-4642(17)30181-5

Cited by 104 publications

(97 citation statements)

References 23 publications

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“…The PARI does not have an extremely high PPV and cannot be expected to detect those patients at higher risk of persistent AKI. However, renal angina aims to screen patients at risk of subsequent persistent AKI, and it is enough that the scoring has a high NPV, similar to the previous studies 9,10 . The PARI, in our analysis, also has a high NPV and is expected to exclude the low risk of persistent AKI (about 87.5% occupied in ICU) and to identify those at potentially high risk of persistent AKI (about 12.5% occupied in ICU).…”

Section: Discussionmentioning

confidence: 73%

A Simple Scoring Method for Predicting the Low Risk of Persistent Acute Kidney Injury in Critically Ill Adult Patients

Matsuura

Iwagami

Moriya

et al. 2020

Sci Rep

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The renal angina index has been proposed to identify patients at high risk of persistent AKI, based on slight changes in serum creatinine and patient conditions. However, a concise scoring method has only been proposed for pediatric patients, and not for adult patients yet. Here, we developed and validated a concise scoring method using data on patients admitted to ICUs in 21 Japanese hospitals from 2012 to 2014. We randomly assigned to either discovery or validation cohorts, identified the factors significantly associated with persistent AKI using a multivariable logistic regression model in the discovery cohort to establish a scoring system, and assessed the validity of the scoring in the validation cohort using receiver operating characteristic analysis and the calibration slope. Among 8,320 patients admitted to the ICUs, persistent AKI was present in 1,064 (12.8%) patients. In the discovery cohort (n = 4,151), ‘hyperbilirubinemia’, ‘sepsis’ and ‘ventilator and/or vasoactive’ with small changes in serum creatinine were selected to establish the scoring. In the validation cohort (n = 4,169), the predicting model based on this scoring had a c-statistic of 0.79 (95%CI, 0.77–0.81) and was well calibrated. In conclusion, we established a concise scoring method to identify potential patients with persistent AKI, which performed well in the validation cohort.

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Section: Discussionmentioning

confidence: 73%

A Simple Scoring Method for Predicting the Low Risk of Persistent Acute Kidney Injury in Critically Ill Adult Patients

Matsuura

Iwagami

Moriya

et al. 2020

Sci Rep

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“…We recommend the use of clinical scoring systems to predict AKI post-injury or when the timing of injury is unknown. The Renal Angina Index (RAI) has emerged as a useful scoring system in children who are critically ill (25). The RAI combines validated clinical risk factors (ICU admission, solid organ or stem cell transplant, mechanical ventilation, and vasopressor need) with evidence for decreased kidney function (increases in serum creatinine or degrees of fluid accumulation) to stratify patients at risk for subsequent severe AKI.…”

Section: Identify Patients Who Are At Risk For Aki Post-injury Earlymentioning

confidence: 99%

The Current State of the Art in Acute Kidney Injury

Devarajan

2020

Front. Pediatr.

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Decades of pre-clinical research have revealed biologic pathways that have suggested potential therapies for acute kidney injury (AKI) in experimental models. However, translating these to human AKI has largely yielded disappointing results. Fortunately, recent discoveries in AKI molecular mechanisms are providing new opportunities for early detection and novel interventions. This review identifies technologies that are revealing the exceptionally complex nature of the normal kidney, the remarkable heterogeneity of the AKI syndrome, and the myriad responses of the kidney to AKI. Based on the current state of the art, novel approaches to improve the bench-to-bedside translation of novel discoveries are proposed. These strategies include the use of unbiased approaches to improve our understanding of human AKI, establishment of irrefutable biologic plausibility for proposed biomarkers and therapies, identification of patients at risk for AKI pre-injury using clinical scores and non-invasive biomarkers, initiation of safe, and effective preventive interventions of pre-injury in susceptible patients, identification of patients who may develop AKI post-injury using electronic triggers, clinical scores, and novel biomarkers, employment of sequential biomarkers to initiate appropriate therapies based on knowledge of the underlying pathophysiology, use of new biomarkers as criteria for enrollment in randomized clinical trials, assessing efficacy, and empowering the drug development process, and early initiation of anti-fibrotic therapies. These strategies are immediately actionable and hold tremendous promise for effective bench-to-bedside translation of novel discoveries that will change the current dismal prognosis of human AKI.

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“…In critically ill children, Basu et al [92] combined risk criteria (solid organ or stem-cell transplantation, mechanical ventilation, or vasoactive drug support) and injury criteria (change in serum creatinine relative to baseline or fluid overload percentage) assessed 12 h after ICU admission into a score named the renal angina index (RAI). They showed that a RAI ≥8 was independently associated with the occurrence of severe AKI at 72 h. In critically ill adults, Malhotra et al [93] developed a risk score including 10 clinical parameters for the prediction of AKI in the first 7 days.…”

Section: Acute Kidney Injury and Critical Care Nephrologymentioning

confidence: 99%

“…Importantly, renoprotective recommendations such as avoidance of nephrotoxic drugs and hyperglycemia, as well as optimization of the hemodynamic status (KDIGO bundle) [102], can prevent AKI in high-risk groups. This was demonstrated in the PrevAKI trial [92], in which patients undergoing cardiac surgery with TIMP2 × IGFBP7 > 0.3 (measured 4 h after cardiopulmonary bypass) were randomized to receive the KDIGO bundle versus standard of care. The investigators showed a significant decrease in the incidence of postoperative AKI when the KDIGO bundle was implemented.…”

Section: Acute Kidney Injury and Critical Care Nephrologymentioning

confidence: 99%

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

et al. 2018

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Background: Although renal replacement therapy prevents death from uremia, survival among patients with acute and chronic kidney diseases (CKD) remains an imperative concern. The expected life span of US dialysis patients 60–64 years of age is approximately 4.5 years; this is similar to that of patients with lung cancer. Despite substantial progress in many medical specialties over the past decades (e.g., notable reductions in myocardial infarction, stroke, and mortality rates in the general population), survival among dialysis patients has not improved significantly over the same period. A few decades ago, HIV infection and AIDS were pretty much a death sentence. Because of progress in HIV treatment, now it can be controlled with a daily pill, and ongoing research is pushing treatment even further and controls the virus with longer-acting treatment. A cure is no longer impossible for HIV and other viral infections such as hepatitis B and C and many malignancies, but so far there is no cure for CKD. Summary: Billions of dollars have been spent on kidney disease research in the past decades, with no tangible progress in clinical practice. The challenges of improving the quantity and quality of trials in nephrology are enormous. The number of randomized controlled trials (RCTs) published in nephrology is lower than that in other medical subspecialties, and most of the big RCTs in nephrology yield negative results. Nephrology studies evaluating hard clinical endpoints or surrogate endpoints are scarce. Key Message: Herein we discuss the slow progress in nephrology research that has impacted clinical practice over the last couple of decades and highlight the major obstacles, challenges, and potential solutions.

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Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study

Abstract: Earlier, better prediction of severe AKI has the potential to improve AKI associated patient outcomes. Compared to isolated, context-free changes in SCr, renal angina risk assessment improved accuracy for prediction of severe AKI in critically ill children and young adults.

Cited by 104 publications

References 23 publications

A Simple Scoring Method for Predicting the Low Risk of Persistent Acute Kidney Injury in Critically Ill Adult Patients

A Simple Scoring Method for Predicting the Low Risk of Persistent Acute Kidney Injury in Critically Ill Adult Patients

The Current State of the Art in Acute Kidney Injury

Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?

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