Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort

Abstract

Background: Neonates with serum creatinine (SCr) rise ≥ 0.3 mg/dL and/or 50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds. Methods: Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1–2 and ≥1 SCr on postnatal days 3–8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups. Results: The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 & ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 & ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity. Conclusion: Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.

Patterns of Urinary Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury in Neonates Receiving Cardiopulmonary Bypass

“…Both the incidence of AKI and the strength of the association between uNGAL and AKI are likely underestimated. Recent work by Askenazi et al suggests that substantial decreases in threshold for absolute sCr rise from current KDIGO criteria may be required to optimally capture neonates with AKI in the first postnatal week [42]. Using Askenazi et al's criteria of sCr rise of 0.1 mg/dL would have yielded a diagnosis of AKI in an additional 24% (18 of 76) of neonates in our cohort.…”

Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

“…This underestimation of diagnosis of AKI at surgery 1 may impact the associations found at surgery 2 and 3 in our longitudinal models. Future studies that include alternate methods for AKI diagnosis, or refined AKI definitions as was recently reported for AKI in neonates of varying gestational ages should be used to enhance diagnostic precision (27).…”

Paucity of renal follow-up by school age after neonatal cardiac surgery

“…16 In children less than 2 years, abnormal estimated glomerular filtration rate was defined as age-based normative values. 17,18 Cardiac surgery-associated acute kidney injury and acute kidney injury recovery definitions Cardiac surgery-associated acute kidney injury was defined based on internationally accepted criteria, the Kidney Disease Improving Global Outcomes guidelines, modified for neonates 19,20 ; we did not incorporate urine output criteria in the acute kidney injury definition. Acute kidney injury was graded as follows: Stage 1 as a serum creatinine rise to 1.5-1.9 times baseline; stage 2 as a serum creatinine rise to 2-2.9 times baseline; and stage 3 as a serum creatinine rise to 3 or more times baseline or initiation of renal replacement therapy.…”