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. 2008 Jul;3(4):948-54.
doi: 10.2215/CJN.05431207. Epub 2008 Apr 16.

Ascertainment and epidemiology of acute kidney injury varies with definition interpretation

Michael Zappitelli  1 , Chirag R Parikh, Ayse Akcan-Arikan, Kimberley K Washburn, Brady S Moffett, Stuart L Goldstein
Affiliations

Ascertainment and epidemiology of acute kidney injury varies with definition interpretation

Michael Zappitelli et al. Clin J Am Soc Nephrol. 2008 Jul.

Abstract

Background and objectives: Differences in defining acute kidney injury (AKI) may impact incidence ascertainment. We assessed the effects of different AKI definition interpretation methods on epidemiology ascertainment.

Design, setting, participants, & measurements: Two groups were studied at Texas Children's Hospital, Houston, Texas: 150 critically ill children (prospective) and 254 noncritically ill, hospitalized children receiving aminoglycosides (retrospective). SCr was collected for 14 d in the prospective study and 21 d in the retrospective study. Children with known baseline serum creatinine (bSCr) were classified by the pediatric Risk, Injury, Failure, Loss, End-Stage Kidney Disease (pRIFLE) AKI definition using SCr change (pRIFLE(DeltaSCr)), estimated creatinine clearance (eCCl) change (pRIFLE(DeltaCCl)), and the Acute Kidney Injury Network (AKIN) definition. In subjects without known bSCr, bSCR was estimated as eCCl = 100 (eCCl(100)) and 120 ml/min per 1.73 m(2) (eCCl(120)), admission SCr (AdmSCr) and lower/upper normative values (NormsMin, NormsMax). The differential impact of each AKI definition interpretation on incidence estimation and severity distribution was evaluated.

Results: pRIFLE(DeltaSCr) and AKIN led to identical AKI distributions. pRIFLE(DeltaCCl) resulted in 14.5% (critically ill) and 11% (noncritical) more patients diagnosed with AKI compared to other methods (P 0.05). Different bSCr estimates led to differences in AKI incidence, from 12% (AdmSCr) to 87.8% (NormsMin) (P 0.05) in the critically ill group and from 4.6% (eCCl(100)) to 43.1% (NormsMin) (P 0.05) in the noncritical group.

Conclusions: AKI definition variation causes interstudy heterogeneity. AKI definition should be standardized so that results can be compared across studies.

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Figures

Figure 1.
Figure 1.
Study summary. (A) In both the critically ill and noncritically ill group, AKI incidence was calculated using pRIFLEΔCCl (following change in eCCl), pRIFLEΔSCr (following change in SCr) and the AKIN definitions. (B) In patients with no known SCr, AKI incidence was calculated using 5 different estimates of baseline SCr: eCCl100 (eCCl = 100 ml/min per 1.73 m2), eCCl120 (eCCl = 120 ml/min per 1.73 m2), admission SCr, minimum and maximum normative values for age and gender. (C) In patients with known baseline SCr, the 5 baseline SCr estimation methods were compared with true baseline SCr. SCr, serum creatinine; AKI, Acute Kidney Injury, pRIFLE, pediatric Risk, Injury, Failure, Loss, End Stage Kidney Disease criteria; eCCl, estimated creatinine clearance; AKIN, Acute Kidney Injury Network; PICU, Pediatric Intensive Care Unit.
Figure 2.
Figure 2.
Comparison of AKI severity distribution when using change in estimated creatinine clearance (ΔCCl), change in serum creatinine (ΔSCr), and the Acute Kidney Injury Network (AKIN) definition in (a) critically ill children and (b) noncritically ill children. ΔCCl, change in eCCl; ΔSCr, change in SCr; AKIN, Acute Kidney Injury Network. *For both the critically ill and noncritically ill children, the proportion of patients with pRIFLEmax R AKI is higher (P < 0.05) when using change in eCCl (ΔCCl) to define AKI, compared with the other 2 methods.
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