Utilization of the renal angina index in PICU of a developing country for prediction of subsequent severe acute kidney injury

Kaur, Raina; Dhooria, Gurdeep Singh; Pooni, Puneet A; Bhat, Deepak; Bhargava, Sumit; Kakkar, Shruti; Arora, Kamal; Bansal, Namita

doi:10.1007/s00467-018-4001-8

Cited by 17 publications

(12 citation statements)

References 18 publications

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“…Moreover, both day 3 AKI and RA + were associated with higher PRISM II scores (indicating greater illness severity), increased rates of inotropic support, mechanical ventilation, RRT utilization, and higher mortality rates. [20] Collectively, our study and these previous investigations highlight a strong relationship between day 3 AKI and higher RAI scores. Furthermore, our results demonstrate that the RAI score on day 0 exhibited superior predictive ability compared to other markers, such as increased serum creatinine from baseline, FO%, and illness severity score (PRISM II), for clinically significant AKI.…”

Section: Discussionsupporting

confidence: 76%

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

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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.

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Section: Discussionsupporting

confidence: 76%

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

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“…The concept of renal angina index (RAI) combines risk factors and early signs of injury, which has been validated and improved to predict AKIs. RAI ≥ 8 is defined as RAI+, and it has been proved to be associated with AKIs and worse prognosis in critically ill patients [7,8,17]. The incidence of AKIs in early RAI+ group was higher than that in early RAI-group in our study.…”

Section: Discussionmentioning

confidence: 47%

“…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%

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

et al. 2020

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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.

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“…The resultant renal angina index score can range from 1 to 40. A cut-off of ≥8 is used to determine renal angina fulfilment [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

uNGAL Predictive Value for Serum Creatinine Decrease in Critically Ill Children

et al. 2022

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Acute kidney injury (AKI) occurs frequently in critically ill children, having an incidence of up to 26.9% and is associated with high morbidity and mortality in pediatric intensive care units (PICU). Currently, the decrease in the glomerular filtration rate is calculated using the serum creatinine levels. Nevertheless, there may be a 48 h delay between the renal injury and measurable increase in creatinine. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been validated in relation to cardiopulmonary bypass in children, being able to detect AKI before the functional change proven by the rise in serum creatinine. Our aim was to study the utility of using uNGAL in the management of critical pediatric patients admitted to our hospital in a six month period, more specifically, its capacity to predict AKI development, alone and in the association with the renal angina index (RAI). Twenty-eight critically ill children aged from 1 day to 15 years have been included. We found that an increase in uNGAL in day 1 of admission in the PICU was significantly correlated with a decrease in creatinine clearance but not anymore in day 3. However, in our sample uNGAL did not show a significant predictability for AKI development nor the supplementary incorporation of RAI into the prediction model. Therefore, apart from cardiac surgery, the efficacy and utility or uNGAL in the management of critically ill children is still questionable. For the best prediction, we will need to incorporate not only the RAI or other PICU scores, but other biomarkers such as KIM-1, urinary cystatin, and IL 18 in larger samples.

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Utilization of the renal angina index in PICU of a developing country for prediction of subsequent severe acute kidney injury

Abstract: RAI could be used as a simple and important bedside tool to predict patients at risk of severe AKI.

Cited by 17 publications

References 18 publications

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

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

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

uNGAL Predictive Value for Serum Creatinine Decrease in Critically Ill Children

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