A New Criterion for Pediatric AKI Based on the Reference Change Value of Serum Creatinine,Journal of the American Society of Nephrology

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A New Criterion for Pediatric AKI Based on the Reference Change Value of Serum Creatinine
Journal of the American Society of Nephrology ( IF 10.3 ) Pub Date : 2018-09-01 , DOI: 10.1681/asn.2018010090
Xin Xu ₁ , Sheng Nie ₁ , Aihua Zhang ₂ , Mao Jianhua ₃ , Hai-Peng Liu ₄ , Huimin Xia ₅ , Hong Xu ₆ , Zhangsuo Liu ₇ , Shipin Feng ₈ , Wei Zhou ₉ , Xuemei Liu ₁₀ , Yonghong Yang ₁₁ , Yuhong Tao ₁₂ , Yunlin Feng ₁₃ , Chunbo Chen ₁₄ , Mo Wang ₁₅ , Yan Zha ₁₆ , Jian-Hua Feng ₁₇ , Qingchu Li ₁₈ , Shuwang Ge ₁₉ , Jianghua Chen ₂₀ , Yongcheng He ₂₁ , Siyuan Teng ₂₂ , Chuanming Hao ₂₃ , Bi-Cheng Liu ₂₄ , Ying Tang ₂₅ , Li-Jun Wang ₂₆ , Jin-Lei Qi ₂₆ , Wenjuan He ₁ , Pinghong He ₁ , Youhua Liu ₁ , Fan Fan Hou ₁

Affiliation

National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China;
Division of Nephrology, Children’s Hospital of Nanjing Medical University, Nanjing, China;
Division of Nephrology, The Children Hospital of Zhejiang University, Hangzhou, China;
Anhui Institute of Pediatric Research, Anhui Provincial Children’s Hospital, Hefei, China;
Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China;
Division of Nephrology, Children’s Hospital of Fudan University, Shanghai, China;
Division of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;
Division of Nephrology, Chengdu Women and Children’s Central Hospital, Chengdu, China;
Division of Nephrology, Shanghai Children’s Medical Center, Shanghai Jiaotong University, Shanghai, China;
Division of Nephrology, Jinan Children’s Hospital, Jinan, China;
Division of Nephrology, Pediatric Medical Research Center, Gansu Province Child’s Hospital, Lanzhou University Second Hospital, Lanzhou, China;
Division of Nephrology, West China Second University Hospital, Sichuan University, Chengdu, China;
Division of Nephrology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China;
Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China;
Division of Nephrology, Children’s Hospital of Chongqing Medical University, Chongqing, China;
Division of Nephrology, Guizhou Provincial People’s Hospital, Guizhou University, Guiyang, China;
Division of Pediatrics, The Second Affiliated Hospital and
Division of Nephrology, Guilin Medical University Affiliated Hospital, Guilin, China;
Division of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
Kidney Disease Center, The First Affiliated Hospital, Zhejiang University, Hangzhou, China;
Center for Nephrology and Urology Shenzhen University, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China;
Division of Nephrology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China;
Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China;
Institute of Nephrology, Zhong Da Hospital, Nanjing, China;
Division of Nephrology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

Background Current definitions of AKI do not take into account serum creatinine’s high variability in children.

Methods We analyzed data from 156,075 hospitalized children with at least two creatinine tests within 30 days. We estimated reference change value (RCV) of creatinine on the basis of age and initial creatinine level in children without kidney disease or known AKI risk, and we used these data to develop a model for detecting pediatric AKI on the basis of RCV of creatinine. We defined pediatric AKI according to pediatric reference change value optimized for AKI in children (pROCK) as creatinine increase beyond RCV of creatinine, which was estimated as the greater of 20 μmol/L or 30% of the initial creatinine level.

Results Of 102,817 children with at least two serum creatinine tests within 7 days, 5432 (5.3%) had AKI as defined by pROCK compared with 15,647 (15.2%) and 10,446 (10.2%) as defined by pediatric RIFLE (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO), respectively. Children with pROCK-defined AKI had significantly increased risk of death (hazard ratio, 3.56; 95% confidence interval, 3.15 to 4.04) compared with those without AKI. About 66% of patients with pRIFLE-defined AKI and 51% of patients with KDIGO-defined AKI, mostly children with initial creatinine level of <30 μmol/L, were reclassified as non-AKI by pROCK, and mortality risk in these children was comparable with risk in those without AKI by all definitions.

Conclusions pROCK criterion improves detection of “true” AKI in children compared with earlier definitions that may lead to pediatric AKI overdiagnosis.

中文翻译：

基于血清肌酐参考变化值的小儿AKI新判据

背景技术当前对AKI的定义并未考虑儿童血清肌酐的高变异性。

方法我们在30天内对至少156,075名住院儿童进行了至少两次肌酐检测的数据进行了分析。我们根据年龄和未患有肾脏疾病或已知AKI风险的儿童的肌酐初始水平估算了肌酐的参考变化值（RCV），并使用这些数据建立了基于肌酐RCV的儿科AKI检测模型。我们根据儿童（pROCK）为超出肌酸酐RCV肌酐升高，这是估计为20更大的用于AKI优化儿科基准值变化量定义的儿科AKI μ摩尔/ L的初始肌酸酐水平的30％。

结果102 817名儿童在7天内进行了至少两次血清肌酐检测，其中pROCK定义的AKI为5432（5.3％），而儿科RIFLE（pRIFLE）和肾脏疾病为15647（15.2％）和10446（10.2％）分别改善全球成果（KDIGO）。与没有AKI的儿童相比，患有pROCK定义的AKI的儿童的死亡风险显着增加（危险比，3.56； 95％的置信区间，3.15至4.04）。约66％的患者用pRIFLE定义的AKI和患者KDIGO定义的AKI 51％，主要是与<30的初始肌酸酐水平的儿童μ摩尔/ L，被重新分类为非AKI通过pROCK，并且在这些儿童的死亡风险在所有定义中，在没有AKI的患者中，风险具有可比性。

结论与早期定义相比，pROCK标准可改善儿童“真实” AKI的检测，这可能导致儿科AKI过度诊断。

更新日期：2018-09-01

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