Abstract

Research Article

Modification of the Renal Angina Index for identifying the need for renal replacement therapy in critically ill pediatric patients

Erin K Stenson*, John T Brinton, Liz Beil, Danielle E Soranno and Katja M Gist

Published: 02 November, 2020 | Volume 4 - Issue 3 | Pages: 070-076

Severe Acute Kidney Injury (AKI) is a common, serious problem affecting critically ill children that lacks effective treatment options. Currently, there are no treatment options for AKI other than supportive care. Continuous renal replacement therapy (CRRT) is employed to reduce Fluid Overload (FO) burden and treat metabolic disturbances in AKI. Identifying patients upon admission who may require CRRT has potential clinical care implications. The aim of this study was to determine if the RAI had diagnostic capabilities to identify patients who would require CRRT.

The analytic cohort consisted of patients who required CRRT and illness severity score matched controls who did not require CRRT at a single center. Patients who required CRRT had higher mortality rates, length of stay, and use of ventilatory and inotropic support. Sensitivity, specificity and area under the receiver operating characteristic curve (AUC) assessed and compared the discriminatory accuracy of three scores: 1) the renal angina index (RAI), 2) serum-creatinine (sCr) based AKI on day 0 and 3) modified RAI created with an additional RAI injury tranche that corresponded to severe stage 3 AKI sCr elevation.

Compared to Day0AKI (AUC 0.78, 0.70-0.87; sensitivity 0.63, 0.45-0.79; specificity 0.93, 0.870.97) and RAI (AUC 0.76, 0.69-0.82; sensitivity 0.94, 0.81-0.99; specificity 0.57, 0.47-0.66), the modified RAI had the highest AUC (0.79; 0.72-0.85) with a high sensitivity (0.91; 0.77-0.98) and moderate specificity (0.65; 0.56-0.75) for prediction of CRRT requirements. As a more accurate tool for discriminating patients in need of CRRT, a modified RAI has numerous potential implications. Identifying patients who ultimately require CRRT at an earlier timepoint may influence timing of CRRT initiation in an attempt to avoid further FO, or may influence nephrotoxin administration. The diagnostic capabilities of the modified RAI may be refined by the addition of urinary biomarkers. These findings should be validated in a larger cohort.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001062 Cite this Article Read Full Article PDF

Keywords:

Acute Kidney Injury; Renal Angina Index; Renal Replacement Therapy

References

  1. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2017; 376: 11-20. PubMed: https://pubmed.ncbi.nlm.nih.gov/27959707/
  2. Slater MB, Anand V, Uleryk EM, Parshuram CS. A systematic review of RIFLE criteria in children, and its application and association with measures of mortality and morbidity. Kidney Int. 2012; 81: 791-798. PubMed: https://pubmed.ncbi.nlm.nih.gov/22258324/
  3. Goldstein SL. Acute kidney injury biomarkers: renal angina and the need for a renal troponin I. BMC Med. 2011; 9: 135.
  4. Basu RK, Zappitelli M, Brunner L, Wang Y, Wong HR, et al. Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int. 2014; 85: 659-667. PubMed: https://pubmed.ncbi.nlm.nih.gov/24048379/
  5. Basu RK, Kaddourah A, Goldstein SL. Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study. Lancet Child Adolesc Health. 2018; 2: 112-120. PubMed: https://pubmed.ncbi.nlm.nih.gov/30035208/
  6. Hanson HR, Carlisle MA, Bensman RS, Byczkowski T, Depinet H, et al. Early prediction of pediatric acute kidney injury from the emergency department: A pilot study. Am J Emerg Med. 2020. PubMed: https://pubmed.ncbi.nlm.nih.gov/32024590/
  7. Sutherland SM, Alexander SR. Continuous renal replacement therapy in children. Pediatr Nephrol. 2012; 27: 2007-2016. PubMed: https://pubmed.ncbi.nlm.nih.gov/22366896/
  8. Gist KM, Selewski DT, Brinton J, Menon S, Goldstein SL, Basu RK. Assessment of the Independent and Synergistic Effects of Fluid Overload and Acute Kidney Injury on Outcomes of Critically Ill Children. Pediatr Crit Care Med. 2020; 21: 170-177. PubMed: https://pubmed.ncbi.nlm.nih.gov/31568240/
  9. Pollack MM, Holubkov R, Funai T, Dean JM, Berger JT, et al. The Pediatric Risk of Mortality Score: Update 2015. Pediatr Crit Care Med. 2016; 17: 2-9. PubMed: https://pubmed.ncbi.nlm.nih.gov/26492059/
  10. KDIGO Guidelines on AKI. Kidney International Supplements. 2012; 2.
  11. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, et al. Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol. 2008; 3: 948-954. PubMed: https://pubmed.ncbi.nlm.nih.gov/18417742/
  12. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982; 143: 29-36. PubMed: https://pubmed.ncbi.nlm.nih.gov/7063747/
  13. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44: 837-845. PubMed: https://pubmed.ncbi.nlm.nih.gov/3203132/
  14. Hayes LW, Oster RA, Tofil NM, Tolwani AJ. Outcomes of critically ill children requiring continuous renal replacement therapy. J Crit Care. 2009; 24: 394-400. PubMed: https://pubmed.ncbi.nlm.nih.gov/19327959/.
  15. Riley AA, Watson M, Smith C, Guffey D, Minard CG, et al. Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation. BMC Nephrol. 2018; 19: 268. PubMed: https://pubmed.ncbi.nlm.nih.gov/30340544/
  16. Alobaidi R, Morgan C, Basu RK, Stenson E, Featherstone R, Majumdar SR, et al. Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018; 172: 257-268. PubMed: https://pubmed.ncbi.nlm.nih.gov/29356810/
  17. Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010; 55: 316-325. PubMed: https://pubmed.ncbi.nlm.nih.gov/20042260/
  18. Gorga SM, Sahay RD, Askenazi DJ, Bridges BC, Cooper DS, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study. Pediatr Nephrol. 2020. 35: 871-882. PubMed: https://pubmed.ncbi.nlm.nih.gov/31953749/
  19. Menon S, Goldstein SL, Mottes T, Fei L, Kaddourah A, et al. Urinary biomarker incorporation into the renal angina index early in intensive care unit admission optimizes acute kidney injury prediction in critically ill children: a prospective cohort study. Nephrol Dial Transplant. 2016; 31: 586-594. PubMed: https://pubmed.ncbi.nlm.nih.gov/26908772/

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Similar Articles

  • Acute Tubulointerstitial Nephritis due to Phenytoin: Case Report
    Nilzete Liberato Bresolin*, Pedro Docusse Junior, Maria Beatriz Cacese Shiozawa, Marina Ratier de Brito Moreira and Natalia Galbiatti Silveira Nilzete Liberato Bresolin*,Pedro Docusse Junior,Maria Beatriz Cacese Shiozawa,Marina Ratier de Brito Moreira,Natalia Galbiatti Silveira. Acute Tubulointerstitial Nephritis due to Phenytoin: Case Report. . 2017 doi: 10.29328/journal.jcn.1001004; 1: 019-025
  • The outcome of Acute Kidney Injury in patients with severe Malaria
    João Egidio Romão Jr* and João Alberto Brandão João Egidio Romão Jr*,João Alberto Brandão. The outcome of Acute Kidney Injury in patients with severe Malaria. . 2017 doi: 10.29328/journal.jcn.1001007; 1: 048-054
  • AngioJetTM rheolytic thrombectomy induced intravascular haemolysis leading to Acute Kidney Injury requiring Dialysis
    Hultin Sebastian*, Murali Karumathil and Nguyen Tam Hultin Sebastian*,Murali Karumathil,Nguyen Tam. AngioJetTM rheolytic thrombectomy induced intravascular haemolysis leading to Acute Kidney Injury requiring Dialysis. . 2018 doi: 10.29328/journal.jcn.1001015; 2: 025-028
  • Challenges of haemodialysis: A single centre experience in South West Nigeria
    Samuel Ayokunle Dada*, Adebukola Bidemi Ajite, Funmilayo Abimbola Ibitoba, Awolowo Anthony Thomas, Oluwamayowa Esther Dada and Olabisi Olamide Deji-Dada Samuel Ayokunle Dada*,Adebukola Bidemi Ajite,Funmilayo Abimbola Ibitoba,Awolowo Anthony Thomas,Oluwamayowa Esther Dada,Olabisi Olamide Deji-Dada. Challenges of haemodialysis: A single centre experience in South West Nigeria . . 2019 doi: 10.29328/journal.jcn.1001026; 3: 055-060
  • Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children
    Ali Mohammed Abu Zeid, Doaa Youssef Mohammed*, Amal Saeed AbdAlazeem, Anas Saad Elsayed mohammed Seddeeq and Ashraf Mohamed Elnaany Ali Mohammed Abu Zeid,Doaa Youssef Mohammed*,Amal Saeed AbdAlazeem,Anas Saad Elsayed mohammed Seddeeq,Ashraf Mohamed Elnaany. Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children. . 2019 doi: 10.29328/journal.jcn.1001032; 3: 093-099
  • Granulomatosis with polyangiitis (GPA) in a 76-year old woman presenting with pulmonary nodule and accelerating acute kidney injury
    Noor Sameh Darwich*, Melissa Schnell and L. Nicholas Cossey Noor Sameh Darwich*,Melissa Schnell,L. Nicholas Cossey. Granulomatosis with polyangiitis (GPA) in a 76-year old woman presenting with pulmonary nodule and accelerating acute kidney injury. . 2020 doi: 10.29328/journal.jcn.1001048; 4: 001-006
  • Biomarkers in acute kidney injury
    Nehomar Pajaro Galvis*, Jorge Rico-Fontalvo, Rodrigo Daza-Arnedo, Maria Ximena Cardona-Blanco, Emilio Abuabara-Franco, Victor Leal-Martínez, Jose Cabrales-Juan, José Correa-Guerrero, José Bohórquez-Rivero, José Sáenz-López, José Restom-Arrieta, Milton Rivera-Moreno, Estefany Rivera-Moreno, Maria Monterrosa-Robles, Alonso Pomares-Lara, Dayana Ayola-Rosales and Ana Alonso-Henriquez Nehomar Pajaro Galvis*,Jorge Rico-Fontalvo,Rodrigo Daza-Arnedo,Maria Ximena Cardona-Blanco,Emilio Abuabara-Franco,Victor Leal-Martínez,Jose Cabrales-Juan,José Correa-Guerrero,José Bohórquez-Rivero,José Sáenz-López,José Restom-Arrieta,Milton Rivera-Moreno,Estefany Rivera-Moreno,Maria Monterrosa-Robles,Alonso Pomares-Lara,Dayana Ayola-Rosales,Ana Alonso-Henriquez. Biomarkers in acute kidney injury. . 2020 doi: 10.29328/journal.jcn.1001056; 4: 027-035
  • Acute kidney injury in Colombian patients with COVID-19 who received kidney support therapy with genius® 90 technology
    Emilio Rey-Vela, Jesús Muñoz, Rodrigo Daza-Arnedo, Rodrigo Daza-Arnedo, Katherin Portela-Buelvas, Nehomar Pájaro-Galvis*, Víctor Leal-Martínez, Emilio Abuabara-Franco, José Cabrales-Juan, Leonardo Marín, Lucas Daza, Samuel Cuadro, Emir Ortiz, María Raad-Sarabia, Cesar Ferrer, Alejandra Prada, Greisy González, Elkin Mendoza, Klearly Tinoco, Jorge Camacho, Joel Ortega, Carlos Tobón, Juan Montes, Jorge Coronado, Luis Salgado-Montiel, José Correa, Fabio Salas, Amilkar Almanza-Hurtado and Miguel Aguilar-Schorborg Emilio Rey-Vela,Jesús Muñoz,Rodrigo Daza-Arnedo,Rodrigo Daza-Arnedo,Katherin Portela-Buelvas,Nehomar Pájaro-Galvis*,Víctor Leal-Martínez,Emilio Abuabara-Franco,José Cabrales-Juan,Leonardo Marín,Lucas Daza,Samuel Cuadro,Emir Ortiz,María Raad-Sarabia,Cesar Ferrer,Alejandra Prada,Greisy González,Elkin Mendoza,Klearly Tinoco,Jorge Camacho,Joel Ortega,Carlos Tobón,Juan Montes,Jorge Coronado,Luis Salgado-Montiel,José Correa,Fabio Salas,Amilkar Almanza-Hurtado,Miguel Aguilar-Schorborg. Acute kidney injury in Colombian patients with COVID-19 who received kidney support therapy with genius® 90 technology. . 2020 doi: 10.29328/journal.jcn.1001059; 4: 056-060
  • COVID-19 related rhabdomyolysis
    Alejandro Munoz-Martinez, Maham Akbar Waheed, Kenar D Jhaveri and Geurys Rojas-Marte* Alejandro Munoz-Martinez,Maham Akbar Waheed,Kenar D Jhaveri,Geurys Rojas-Marte*. COVID-19 related rhabdomyolysis. . 2020 doi: 10.29328/journal.jcn.1001061; 4: 065-069
  • Modification of the Renal Angina Index for identifying the need for renal replacement therapy in critically ill pediatric patients
    Erin K Stenson*, John T Brinton, Liz Beil, Danielle E Soranno and Katja M Gist Erin K Stenson*,John T Brinton,Liz Beil,Danielle E Soranno,Katja M Gist. Modification of the Renal Angina Index for identifying the need for renal replacement therapy in critically ill pediatric patients. . 2020 doi: 10.29328/journal.jcn.1001062; 4: 070-076

Recently Viewed

Read More

Most Viewed

Read More

Help ?