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

David Askenazi, Carolyn Abitbol, Louis Boohaker, Russell Griffin, Rupesh Raina, Joshua Dower, T Keefe Davis, Patricio E Ray, Sofia Perazzo, Marissa DeFreitas, Lawrence Milner, Namasivayam Ambalavanan, F Sessions Cole, Erin Rademacher, Michael Zappitelli, Maroun Mhanna, 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, David Askenazi, Carolyn Abitbol, Louis Boohaker, Russell Griffin, Rupesh Raina, Joshua Dower, T Keefe Davis, Patricio E Ray, Sofia Perazzo, Marissa DeFreitas, Lawrence Milner, Namasivayam Ambalavanan, F Sessions Cole, Erin Rademacher, Michael Zappitelli, Maroun Mhanna, 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

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.

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:
Figure 1:
Flow diagram of infants and reasons for exclusion
Figure 2:
Figure 2:
Incidence of AKI and mortality by absolute and percent changes in SCr

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Source: PubMed

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