Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

Selewski, David T.; Cornell, Timothy T.; Heung, Michael; Troost, Jonathan P.; Ehrmann, Brett J.; Lombel, Rebecca M.; Blatt, Neal B.; Luckritz, Kera E.; Hieber, Sue; Gajarski, Robert J.; Kershaw, David B.; Shanley, Thomas P.; Gipson, Debbie S.

doi:10.1007/s00134-014-3391-8

Cited by 205 publications

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“…Current definitions have demonstrated that even small degrees of AKI are associated with increased morbidity and mortality in children and adults. 1,3,43 This empirical definition has evolved based on observational data from millions of patients and hundreds of studies into the Kidney Diseases: Improving Global Outcomes (KDIGO) AKI definition published in 2013, maintaining a 3-tiered categorical staging model depicting mild, moderate, and severe stages of AKI. 44 The use of standardized definitions of AKI has allowed comparison between studies and was a fundamental first step that has been integral to the study of AKI in medicine.…”

Section: Definition Of Neonatal Akimentioning

confidence: 99%

“…Some have suggested that the SCr should rise to an absolute value of .0.5 mg/dL and meet the previous criteria to qualify as AKI. 1,12 …”

Section: Definition Of Neonatal Akimentioning

confidence: 99%

“…[1][2][3][4] It has become apparent that children who survive an episode of AKI are at increased risk for chronic kidney disease (CKD) and warrant long-term follow-up. 5,6 Neonatal AKI studies have begun to show similar conclusions: AKI is common and is associated with poor outcomes.…”

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Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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Section: Definition Of Neonatal Akimentioning

confidence: 99%

“…Some have suggested that the SCr should rise to an absolute value of .0.5 mg/dL and meet the previous criteria to qualify as AKI. 1,12 …”

Section: Definition Of Neonatal Akimentioning

confidence: 99%

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Neonatal Acute Kidney Injury

et al. 2015

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“…These criteria provide a standardized simple way of categorizing AKI and may be a better predictor of morbidity and mortality. The RIFLE, AKIN, and KDIGO criteria are summarized in Table 1. KDIGO criteria of AKI were validated in a pediatric critical care population (15). Studies of AKI using KDIGO criteria in orthotopic lung transplant recipients, after cardiac surgery, and in septic patients in critical care units have been published recently, but, to the best of our knowledge, there is no study in the English literature investigating AKI in a cirrhotic population using KDIGO criteria (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

KDIGO (Kidney Disease: Improving Global Outcomes) criteria as a predictor of hospital mortality in cirrhotic patients

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et al. 2016

Turk J Gastroenterol

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“…Another large cohort study in 580 patients with out-of-hospital cardiac arrest found severe AKI in 43 % of the patients and the association with mortality but not with neurological outcome [3]. Last, it must be noted that first validation of the Kidney Disease Improving Global Outcomes (KDIGO) criteria was performed in a large pediatric population [4]. …”

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Focus on acute kidney injury and fluids

2016

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An acute deterioration of kidney function, currently known as acute kidney injury (AKI), frequently develops in ICU patients and is always bad news. In this overview we will highlight recent findings related to its diagnosis, epidemiology, and extracorporeal treatment. Epidemiology of AKIThe AKI-EPI study, a worldwide cross-sectional study on the occurrence of acute kidney injury (AKI) in the first week in intensive care unit (ICU), found AKI in 57 % of the 1800 included patients. AKI severity was associated with adverse patient and kidney outcome at hospital discharge [1]. Analysis of a large cohort (32,045) in a single medical center confirmed the high prevalence (74.5 %) and further illustrated that both AKI severity and duration and the criteria used to define it (creatinine, urine output, or both) had significant impact on short-and long-term outcomes [2]. Another large cohort study in 580 patients with out-of-hospital cardiac arrest found severe AKI in 43 % of the patients and the association with mortality but not with neurological outcome [3]. Last, it must be noted that first validation of the Kidney Disease Improving Global Outcomes (KDIGO) criteria was performed in a large pediatric population [4]. Assessment of renal prognosis and of renal functionSeveral studies demonstrated limits of usual renal dysfunction criteria and of biomarkers in assessing renal function or predicting renal prognosis. First, short episodes of oliguria in ICU patients are frequent and do not always predict subsequent AKI by creatinine criteria. Legrand et al. explored whether AKI biomarkers could predict worsening of kidney function (WKF) in 111 critically ill patients with first episode of oliguria. Interestingly, although plasma neutrophil gelatinase-associated lipocalin (NGAL) might improve the prediction of WKF, the biomarker had a similar performance to serum creatinine [5]. Furthermore, the follow-up of the furosemide stress test study found limited performance of biomarkers to predict WKF, which were largely outperformed by the furosemide stress test [6].The gold standard for glomerular filtration rate (GFR) determination is inulin clearance, but this cannot be measured easily. Carlier and co-workers compared inulin clearance with creatinine clearance and several creatinine and/or cystatin C-based GFR equations in 68 critically ill patients with stable kidney function. As a result of tubular secretion of creatinine, measured creatinine clearance resulted in a slight overestimation of GFR while creatinine-based equations had the worst performance with overestimation of the true GFR; the overestimation increased with hospital stay [7]. This confirms previous findings showing increasing differences between discharge estimated GFR (eGFR) and creatinine clearance with increasing ICU stay in both AKI and non-AKI patients. Reduced creatinine excretion resulting from muscle loss was the main determinant of this difference [8]. Since cystatin is not influenced by muscle mass, the cystatin-based equations did not share the hospi...

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Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

Cited by 205 publications

References 25 publications

Neonatal Acute Kidney Injury

Neonatal Acute Kidney Injury

KDIGO (Kidney Disease: Improving Global Outcomes) criteria as a predictor of hospital mortality in cirrhotic patients

Focus on acute kidney injury and fluids

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