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A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients.
Ann Thorac Surg. 2014 Jan; 97(1):202-10.AT

Abstract

BACKGROUND

The pediatric-modified Risk, Injury, Failure and Loss, and End-Stage (pRIFLE) criteria and a different but conceptually similar system termed Acute Kidney Injury Network (AKIN) were created to standardize the definition of acute kidney injury (AKI) in children. Kidney Disease: Improving Global Outcomes (KDIGO) currently recommends a combination of AKIN and pRIFLE in AKI. This study aimed to compare the three classifications for predicting AKI in pediatric patients undergoing cardiac operations.

METHODS

We analyzed the prospectively collected data of 1,489 consecutive pediatric patients undergoing cardiac operations between January 2004 and December 2008. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance levels calculated by the Schwartz equation.

RESULTS

AKI was present in 285 (20%), 481 (34%), and 409 (29%) patients according to the AKIN, pRIFLE, and KDIGO systems, respectively. The KDIGO classification categorized 121 patients (8%) who were placed in the AKIN 0 category, whereas the pRIFLE system categorized 74 (5%) in KDIGO 0 and 200 (14%) in AKIN 0 stages as having an AKI. The overall mortality rate was 3.9%. The KDIGO stage III (odds ratio [OR], 18.8; 95% confidence interval [CI], 9.6 to 36.6, p < 0.001), the AKIN stage III (OR, 38.3; 95% CI, 20.6 to 70.9, p < 0.001), and pRIFLE failure group (OR, 13.6, 95% CI, 7 to 26.3; p < 0.001) were associated with increased mortality.

CONCLUSIONS

The pRIFLE system was the most sensitive test in detecting AKI, and this was especially so in the infant age group and also in the early identification of AKI in low-risk patients. The AKIN system was more specific and detected mostly high-risk patients across all age groups. The KDIGO classification system fell between pRIFLE and AKIN in performance. All three had increasing severity of AKI associated with mortality.

Authors+Show Affiliations

School of PhD Studies, Semmelweis University, Budapest, Hungary.School of PhD Studies, Semmelweis University, Budapest, Hungary.School of PhD Studies, Semmelweis University, Budapest, Hungary; Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia.Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.Department of Anesthesia and Intensive Care, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary; Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary. Electronic address: szekelya@kardio.hu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24206964

Citation

Lex, Daniel J., et al. "A Comparison of the Systems for the Identification of Postoperative Acute Kidney Injury in Pediatric Cardiac Patients." The Annals of Thoracic Surgery, vol. 97, no. 1, 2014, pp. 202-10.
Lex DJ, Tóth R, Cserép Z, et al. A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg. 2014;97(1):202-10.
Lex, D. J., Tóth, R., Cserép, Z., Alexander, S. I., Breuer, T., Sápi, E., Szatmári, A., Székely, E., Gál, J., & Székely, A. (2014). A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. The Annals of Thoracic Surgery, 97(1), 202-10. https://doi.org/10.1016/j.athoracsur.2013.09.014
Lex DJ, et al. A Comparison of the Systems for the Identification of Postoperative Acute Kidney Injury in Pediatric Cardiac Patients. Ann Thorac Surg. 2014;97(1):202-10. PubMed PMID: 24206964.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. AU - Lex,Daniel J, AU - Tóth,Roland, AU - Cserép,Zsuzsanna, AU - Alexander,Stephen I, AU - Breuer,Tamás, AU - Sápi,Erzsébet, AU - Szatmári,András, AU - Székely,Edgár, AU - Gál,János, AU - Székely,Andrea, Y1 - 2013/11/06/ PY - 2013/05/28/received PY - 2013/08/28/revised PY - 2013/09/04/accepted PY - 2013/11/12/entrez PY - 2013/11/12/pubmed PY - 2014/3/4/medline KW - 18 KW - AKI KW - AKIN KW - Acute Kidney Injury Network KW - CI KW - CPB KW - CrCl KW - DHCA KW - ICU KW - IQR KW - KDIGO KW - Kidney Disease: Improving Global Outcomes KW - LOS KW - OR KW - Pediatric-modified Risk Injury Failure Loss and End-stage renal disease KW - RACHS KW - RBC KW - RRT KW - Risk Adjustment for Congenital Heart Surgery KW - SCr KW - SD KW - acute kidney injury KW - cardiopulmonary bypass KW - confidence interval KW - creatinine clearance KW - deep hypothermic cardiac arrest KW - eCrCl KW - estimated creatinine clearance KW - intensive care unit KW - interquartile range KW - low-output syndrome KW - odds ratio KW - pRIFLE KW - red blood cells KW - renal replacement therapy KW - serum creatinine KW - standard deviation KW - w/o KW - without SP - 202 EP - 10 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 97 IS - 1 N2 - BACKGROUND: The pediatric-modified Risk, Injury, Failure and Loss, and End-Stage (pRIFLE) criteria and a different but conceptually similar system termed Acute Kidney Injury Network (AKIN) were created to standardize the definition of acute kidney injury (AKI) in children. Kidney Disease: Improving Global Outcomes (KDIGO) currently recommends a combination of AKIN and pRIFLE in AKI. This study aimed to compare the three classifications for predicting AKI in pediatric patients undergoing cardiac operations. METHODS: We analyzed the prospectively collected data of 1,489 consecutive pediatric patients undergoing cardiac operations between January 2004 and December 2008. AKI presence and severity was assessed for each classification using the change in serum creatinine and estimated creatinine clearance levels calculated by the Schwartz equation. RESULTS: AKI was present in 285 (20%), 481 (34%), and 409 (29%) patients according to the AKIN, pRIFLE, and KDIGO systems, respectively. The KDIGO classification categorized 121 patients (8%) who were placed in the AKIN 0 category, whereas the pRIFLE system categorized 74 (5%) in KDIGO 0 and 200 (14%) in AKIN 0 stages as having an AKI. The overall mortality rate was 3.9%. The KDIGO stage III (odds ratio [OR], 18.8; 95% confidence interval [CI], 9.6 to 36.6, p < 0.001), the AKIN stage III (OR, 38.3; 95% CI, 20.6 to 70.9, p < 0.001), and pRIFLE failure group (OR, 13.6, 95% CI, 7 to 26.3; p < 0.001) were associated with increased mortality. CONCLUSIONS: The pRIFLE system was the most sensitive test in detecting AKI, and this was especially so in the infant age group and also in the early identification of AKI in low-risk patients. The AKIN system was more specific and detected mostly high-risk patients across all age groups. The KDIGO classification system fell between pRIFLE and AKIN in performance. All three had increasing severity of AKI associated with mortality. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/24206964/A_comparison_of_the_systems_for_the_identification_of_postoperative_acute_kidney_injury_in_pediatric_cardiac_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(13)02011-0 DB - PRIME DP - Unbound Medicine ER -