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

doi:10.1038/s41390-018-0249-8

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

Pediatrics

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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.

Original language	English
Pages (from-to)	329-338
Number of pages	10
Journal	Pediatric Research
Volume	85
Issue number	3
DOIs	https://doi.org/10.1038/s41390-018-0249-8
State	Published - Feb 1 2019

Bibliographical note

Publisher Copyright:
© 2019, International Pediatric Research Foundation, Inc.

Funding

Competing interests: 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. For full disclosure, we provide here an additional list of other author’s commitments and funding sources that are not directly related to this study: David J Askenazi serves on the speaker board for Baxter (Baxter, USA), and the Acute Kidney Injury (AKI) Foundation (Cincinnati, OH, USA); he also receives grant funding for studies not related to this manuscript from National Institutes of Health—National Institutes of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK, R01 DK103608 and NIH-FDA, R01 FD005092). Jennifer G Jetton is supported by the University of Iowa Institute for Clinical and Translational Sciences NIH U54TR001356. Juan C. Kupferman is on the speaker’s Bureau and consultant for Alexion Pharmaceuticals. Robert Woroniecki is supported by the Department of Pediatrics at Stony Brook Children’s hospital (NY, USA). AWAKEN investigators at the Canberra Hospital were supported by the Canberra Hospital Private Practice fund, and investigators at University of Virginia Children’s Hospital were supported by a 100 Women Who Care Grant (100 Women Charitable Foundation, CA, USA). Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, for the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), as well as support for some of the AWAKEN investigators at UAB (L.B.J., R.J.G.). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB), and is funded by Children’s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Finally, the AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (CTSC, NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356). Funding sources for this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Funders	Funder number
Children’s Hospital of Alabama
University of Iowa Institute for Clinical and Translational Science
University of Iowa Institute for Clinical and Translational Sciences NIH
National Institutes of Health (NIH)	UL1TR001417, UL1TR001449
National Center for Advancing Translational Sciences (NCATS)	U54TR001356

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1038/s41390-018-0249-8

Cite this

@article{fd85b099f5c542ff80b7bbaca381ce15,

title = "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 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.",

author = "David Askenazi and Carolyn Abitbol and Louis Boohaker and Russell Griffin and Rupesh Raina and Joshua Dower and Davis, \{T. Keefe\} and Ray, \{Patricio E.\} and Sofia Perazzo and Marissa DeFreitas and Lawrence Milner and Namasivayam Ambalavanan and Cole, \{F. Sessions\} and Erin Rademacher and Michael Zappitelli and Maroun Mhanna and Selewski, \{David T.\} and Subrata Sarkar and Alison Kent and Jeffery Fletcher and Shahnaz Duara and Charlton, \{Jennifer R.\} and Swanson, \{Jonathan R.\} and Ronnie Guillet and Carl D{\textquoteright}Angio and Ayesa Mian and Deepak Kumar and Jetton, \{Jennifer G.\} and Brophy, \{Patrick D.\} and Colaizy, \{Tarah T.\} and Klein, \{Jonathan M.\} and Arikan, \{Ayse Akcan\} and Rhee, \{Christopher J.\} and Goldstein, \{Stuart L.\} and Nathan, \{Amy T.\} and Kupferman, \{Juan C.\} and Alok Bhutada and Shantanu Rastogi and Elizabeth Bonachea and John Mahan and Alexandra Smith and Mamta Fuloria and Kimberly Reidy and Kaskel, \{Frederick J.\} and Soranno, \{Danielle E.\} and Jason Gien and Gist, \{Katja M.\} and Chishti, \{Aftab S.\} and Mina Hanna and Sangeeta Hingorani",

note = "Publisher Copyright: {\textcopyright} 2019, International Pediatric Research Foundation, Inc.",

year = "2019",

month = feb,

day = "1",

doi = "10.1038/s41390-018-0249-8",

language = "English",

volume = "85",

pages = "329--338",

number = "3",

}

TY - JOUR

T1 - Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort

AU - Askenazi, David

AU - Abitbol, Carolyn

AU - Boohaker, Louis

AU - Griffin, Russell

AU - Raina, Rupesh

AU - Dower, Joshua

AU - Davis, T. Keefe

AU - Ray, Patricio E.

AU - Perazzo, Sofia

AU - DeFreitas, Marissa

AU - Milner, Lawrence

AU - Ambalavanan, Namasivayam

AU - Cole, F. Sessions

AU - Rademacher, Erin

AU - Zappitelli, Michael

AU - Mhanna, Maroun

AU - Selewski, David T.

AU - Sarkar, Subrata

AU - Kent, Alison

AU - Fletcher, Jeffery

AU - Duara, Shahnaz

AU - Charlton, Jennifer R.

AU - Swanson, Jonathan R.

AU - Guillet, Ronnie

AU - D’Angio, Carl

AU - Mian, Ayesa

AU - Kumar, Deepak

AU - Jetton, Jennifer G.

AU - Brophy, Patrick D.

AU - Colaizy, Tarah T.

AU - Klein, Jonathan M.

AU - Arikan, Ayse Akcan

AU - Rhee, Christopher J.

AU - Goldstein, Stuart L.

AU - Nathan, Amy T.

AU - Kupferman, Juan C.

AU - Bhutada, Alok

AU - Rastogi, Shantanu

AU - Bonachea, Elizabeth

AU - Mahan, John

AU - Smith, Alexandra

AU - Fuloria, Mamta

AU - Reidy, Kimberly

AU - Kaskel, Frederick J.

AU - Soranno, Danielle E.

AU - Gien, Jason

AU - Gist, Katja M.

AU - Chishti, Aftab S.

AU - Hanna, Mina

AU - Hingorani, Sangeeta

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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.

AB - 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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U2 - 10.1038/s41390-018-0249-8

DO - 10.1038/s41390-018-0249-8

M3 - Article

C2 - 30643188

AN - SCOPUS:85059950208

SN - 0031-3998

VL - 85

SP - 329

EP - 338

JO - Pediatric Research

JF - Pediatric Research

IS - 3

ER -

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

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

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