Observational Study

. 2019 Feb;85(3):329-338.

doi: 10.1038/s41390-018-0249-8. Epub 2018 Dec 13.

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

David Askenazi¹, Carolyn Abitbol², Louis Boohaker³, Russell Griffin⁴, Rupesh Raina⁵, Joshua Dower⁶, T Keefe Davis⁷, Patricio E Ray⁸, Sofia Perazzo⁸, Marissa DeFreitas², Lawrence Milner⁶, Namasivayam Ambalavanan³, F Sessions Cole⁷, Erin Rademacher⁹, Michael Zappitelli¹⁰, Maroun Mhanna⁵; Neonatal Kidney Collaborative

Collaborators, Affiliations

Collaborators

Neonatal Kidney Collaborative:
David T Selewski, Subrata Sarkar, Alison Kent, Jeffery Fletcher, Shahnaz Duara, Jennifer R Charlton, Jonathan R Swanson, Ronnie Guillet, Carl D'Angio, Ayesa Mian, Deepak Kumar, Jennifer G Jetton, Patrick D Brophy, Tarah T Colaizy, Jonathan M Klein, Ayse Akcan Arikan, Christopher J Rhee, Stuart L Goldstein, Amy T Nathan, Juan C Kupferman, Alok Bhutada, Shantanu Rastogi, Elizabeth Bonachea, John Mahan, Alexandra Smith, Mamta Fuloria, Kimberly Reidy, Frederick J Kaskel, Danielle E Soranno, Jason Gien, Katja M Gist, Aftab S Chishti, Mina H Hanna, Sangeeta Hingorani, Michelle Starr, Sunny Juul, Craig S Wong, Catherine Joseph, Tara DuPont, Robin Ohls, Amy Staples, Surender Khokhar, Mary Revenis, Sidharth K Sethi, Smriri Rohatgi, Cherry Mammen, Anne Synnes, Sanjay Wazir, Pia Wintermark, Robert Woroniecki, Shanty Sridhar, Susan Ingraham, Arwa Nada

Affiliations

¹ Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA. daskenazi@peds.uab.edu.
² Holtz Children's Hospital, University of Miami, Miami, FL, USA.
³ Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
⁶ Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
⁷ Washington University, St. Louis, MO, USA.
⁸ Children's National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington, DC, USA.
⁹ Golisano Children's Hospital, University of Rochester, Rochester, NY, USA.
¹⁰ Toronto Hospital for Sick Children, University of Toronto, Toronto, Canada.

PMID: 30643188
PMCID: PMC6377843
DOI: 10.1038/s41390-018-0249-8

Observational Study

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

David Askenazi et al. Pediatr Res. 2019 Feb.

. 2019 Feb;85(3):329-338.

doi: 10.1038/s41390-018-0249-8. Epub 2018 Dec 13.

Authors

Collaborators

Neonatal Kidney Collaborative:
David T Selewski, Subrata Sarkar, Alison Kent, Jeffery Fletcher, Shahnaz Duara, Jennifer R Charlton, Jonathan R Swanson, Ronnie Guillet, Carl D'Angio, Ayesa Mian, Deepak Kumar, Jennifer G Jetton, Patrick D Brophy, Tarah T Colaizy, Jonathan M Klein, Ayse Akcan Arikan, Christopher J Rhee, Stuart L Goldstein, Amy T Nathan, Juan C Kupferman, Alok Bhutada, Shantanu Rastogi, Elizabeth Bonachea, John Mahan, Alexandra Smith, Mamta Fuloria, Kimberly Reidy, Frederick J Kaskel, Danielle E Soranno, Jason Gien, Katja M Gist, Aftab S Chishti, Mina H Hanna, Sangeeta Hingorani, Michelle Starr, Sunny Juul, Craig S Wong, Catherine Joseph, Tara DuPont, Robin Ohls, Amy Staples, Surender Khokhar, Mary Revenis, Sidharth K Sethi, Smriri Rohatgi, Cherry Mammen, Anne Synnes, Sanjay Wazir, Pia Wintermark, Robert Woroniecki, Shanty Sridhar, Susan Ingraham, Arwa Nada

Affiliations

¹ Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA. daskenazi@peds.uab.edu.
² Holtz Children's Hospital, University of Miami, Miami, FL, USA.
³ Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
⁶ Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
⁷ Washington University, St. Louis, MO, USA.
⁸ Children's National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington, DC, USA.
⁹ Golisano Children's Hospital, University of Rochester, Rochester, NY, USA.
¹⁰ Toronto Hospital for Sick Children, University of Toronto, Toronto, Canada.

PMID: 30643188
PMCID: PMC6377843
DOI: 10.1038/s41390-018-0249-8

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 and ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 and ≥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.

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Conflict of interest statement

Conflict of interest disclosures

All authors declare no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication.

Figures

**Figure 1:**
Flow diagram of infants and reasons for exclusion

**Figure 2:**
Incidence of AKI and mortality by absolute and percent changes in SCr

See this image and copyright information in PMC

References

1. Wong JH, Selewski DT, Yu S, et al. 2016. Severe Acute Kidney Injury Following Stage 1 Norwood Palliation: Effect on Outcomes and Risk of Severe Acute Kidney Injury at Subsequent Surgical Stages. Pediatr Crit Care Med 17:615–623. - PubMed
1. Taylor ML, Carmona F, Thiagarajan RR, Westgate L, Ferguson MA, del Nido PJ, Rajagopal SK 2013. Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg 146:146–152. - PubMed
1. dos Santos El Halal MG, Carvalho PR 2013. Acute kidney injury according to pediatric RIFLE criteria is associated with negative outcomes after heart surgery in children. Pediatr Nephrol 28:1307–1314. - PubMed
1. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, Schneider J 2012. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 94:1589–1595. - PubMed
1. Mathur NB, Agarwal HS, Maria A 2006. Acute renal failure in neonatal sepsis. Indian J Pediatr 73:499–502. - PubMed

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

Collaborators

Affiliations

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

Authors

Collaborators

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Abstract

Conflict of interest statement

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References

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