Prediction of Severe Acute Kidney Injury using Renal Angina Index in a Pediatric Intensive Care Unit

Gawadia, Jitendra; Mishra, Kirtisudha; Kumar, M. Ravi; Saikia, Diganta

doi:10.1007/s13312-019-1587-2

Cited by 17 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that early RAI+ demonstrated better prediction for AKIs than early FO+ and early SCr > base in children with septic shock. The performance of early RAI+ and early SCr > base in predicting AKIs in our study were parallel with that in critically ill patients [8,9]. The reason why RAI is better than FO and SCr > base in predicting AKIs maybe that RAI combines early signs of renal injury with the risk factors.…”

Section: Discussionsupporting

confidence: 75%

“…The concept of renal angina index (RAI) combines risk factors and early signs of injury, intending to stratify patients at risk to avoid subsequent AKIs [ 6 ]. According to reports, RAI can improve accuracy for prediction of AKIs in critically ill children and young adults [ 7 – 9 ]. However, there are no reports of RAI used to predict AKI in patients with septic shock.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

et al. 2020

View full text Add to dashboard Cite

Background: Acute kidney injury (AKI) is independently related to the adverse outcome of septic shock, but it lacks effective early predictors. Renal anginal index (RAI) was used to predict subsequent severe AKI (AKIs) in critically ill patients. The application of RAI in children with septic shock has not been reported. This study aims to evaluate the efficacy of early RAI in predicting subsequent AKIs within 3 days after PICU admission in children with septic shock by comparing with early fluid overload (FO) and early creatinine elevation. Methods: Sixty-six children admitted to PICU aged 1 month to 16 years old, with septic shock from January 2016 to December 2019 were analyzed retrospectively. According to the 2012 Kidney Disease Improving Global outcomes (KDIGO) criteria, AKIs was defined by the KDIGO stage ≥2 within 3 days after PICU admission. Early RAI positive (RAI+) was defined as RAI ≥ 8 within 12 h of PICU admission. Any elevation of serum creatinine (SCr) over baseline within 12 h after PICU admission was denoted as "Early SCr > base". Early FO positive (FO+) was defined as FO > 10% within 24 h of PICU admission. Results: Of 66 eligible cases, the ratio of early RAI+, early SCr > base, early FO+ was 57.57, 59.09 and 16.67% respectively. The incidence of AKIs in early RAI+ group (78.94%) was higher than that in early RAI-group (21.42%) (p = 0.04), and there was no significant difference compared with the early FO+ group (71.79%) and early SCr > base group (81.82%) (P > 0.05). After adjustment for confounders, early RAI+ was independently associated with the occurrence of AKIs within 3 days (OR 10.04, 95%CI 2.39-42.21, p < 0.01). The value of early RAI+ (AUC = 0.78) to identify patients at high risk of AKIs was superior to that of early SCr > base (AUC = 0.70) and early FO+ (AUC = 0.58). A combination of serum lactate with early RAI+ improved the predictive performance for assessing AKIs (AUC = 0.83). Conclusions: Early RAI could be used as a more convenient and effective index to predict the risk of AKIs in children with septic shock within 3 days. Early RAI+ combined with serum lactate improved the predictive performance for assessing AKIs.

show abstract

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Additionally, the RAI showed high effectiveness in ruling out children at low risk of AKI, with a specificity of 95% and a NPPV of 91%. These findings are consistent with the results of the AWARE study, [18] Basu et al, [14] and other relevant studies, [20–22] which also demonstrated that the RAI outperformed traditional markers of renal injury and exhibited increased predictive accuracy.…”

Section: Discussionsupporting

confidence: 92%

Renal angina index in critically ill children as an applicable and reliable tool in the prediction of severe acute kidney injury: Two tertiary centers’ prospective observational study from the Middle East

Soliman,

Al-Ghamdi,

Abukhatwah

et al. 2023

Medicine

View full text Add to dashboard Cite

Acute kidney damage (AKI) is a common cause of pediatric intensive care unit (PICU) admissions. Implementing a reno-protective strategy for AKI prediction can significantly enhance outcomes. The renal angina index (RAI) is a risk stratification tool used to predict severe AKI. We aim to assess the reliability and accuracy of the RAI scoring system in predicting AKI as compared to other conventional AKI markers. A prospective, observational study was conducted in the PICU of 2 tertiary medical centers in the Middle East. A total of 446 patients, aged 1-month to 14-years, without chronic kidney disease were enrolled. The RAI was calculated using the renal risk and renal injury score within the first 8 to 12 hours of admission. The accuracy of RAI was compared to changes in serum creatinine from baseline. The outcome was assessed on Day 3 for presence of AKI according to the kidney disease improving global outcome (KDIGO) criteria and associated sequelae. A positive RAI (RA+) was defined as RAI readings ≥ 8. Among the patients, 89 (19.9%) had a positive RAI within the first 8 to 12 hours of admission. The RA + group had a significantly higher occurrence of Day 3 severe AKI (KDIGO stages 2&3) compared to the RA− group (60.6% vs 4.2%, P < .001). The RA + group also had a significantly higher utilization of renal replacement therapy (RRT) (21.3% vs 1.1%, P < .001), longer mean PICU length of stay in days (11.1 ± 3.5 vs 5.5 ± 2.1, P < .001), and increased mortality (31.4% vs 2.8%, P < .001) compared to the RA− group. The RAI score demonstrated superior predictive ability for Day 3 AKI, with a sensitivity of 72%, specificity of 95%, and area under the curve (AUC) of 0.837, compared to changes in serum creatinine from baseline (sensitivity: 65%, specificity: 89%, AUC: 0.773), fluid overload (sensitivity: 43.7%, specificity: 79%, AUC: 0.613), and illness severity scores (sensitivity: 52.4%, specificity: 80.5%, AUC: 0.657). RAI proved to be a reliable and rapid bedside test for identifying critically ill children at risk of developing severe AKI. This enables physicians to implement reno-protective measures and intervene early, thereby improving prognosis.

show abstract

“…In an earlier study from India, we demonstrated that RAI was better than traditional markers of AKI and illness severity scores with high AUC in RAI ≥8, and higher negative predictive values for RAI <8 [8]. The study [9], published in the current issue of Indian Pediatrics, adds on to the evidence that day 0 RAI has a good sensitivity, specificity, and negative predictive value for AKI on day 3 of admission. A recent study from New Delhi [10] added that RAI thresholds ≥12 or ≥20 had higher specificities, Youden index, and positive predictive value than that of RAI ≥8 in discriminating severe AKI on day 3 or 7, and distinguished between patients with and without need for dialysis.…”

Section: Risk Stratification For Acute Kidney Injury In Critically-ilmentioning

confidence: 65%

Risk Stratification for Acute Kidney Injury in Critically-ill Children

Sethi

Raina

2019

Indian Pediatr

View full text Add to dashboard Cite

Prediction of Severe Acute Kidney Injury using Renal Angina Index in a Pediatric Intensive Care Unit

Cited by 17 publications

References 21 publications

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children

Renal angina index in critically ill children as an applicable and reliable tool in the prediction of severe acute kidney injury: Two tertiary centers’ prospective observational study from the Middle East

Risk Stratification for Acute Kidney Injury in Critically-ill Children

Contact Info

Product

Resources

About