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Creatinine correction to account for fluid overload in children with acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: an initial exploratory report

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Abstract

Background

Creatinine is distributed between the intracellular and extracellular compartments, and as a result, the measurement of its concentration is strongly related to the fluid status of the patient. An interest has been shown in correcting measured serum creatinine levels according to the fluid balance in order to better specify the degree of acute kidney injury (AKI).

Methods

We conducted a retrospective observational study of 33 children, aged 0 to 5 years, admitted to the pediatric intensive care unit for acute respiratory distress syndrome treated by extracorporeal membrane oxygenation. We compared measured and corrected creatinine and assessed the degree of agreement between these values using both Cohen’s kappa and Krippendorff’s alpha coefficient.

Results

In our cohort, 37% of the classifications made according to measured creatinine levels were erroneous and, in the majority of cases, the degree of AKI was underestimated.

Conclusion

Correction of the measured creatinine value according to the degree of fluid overload may result in more accurate diagnosis of AKI.

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Abbreviations

AKI:

Acute kidney injury

KRT:

Kidney replacement therapy

PARDS:

Pediatric acute respiratory distress syndrome

RIFLE:

Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease

KDIGO:

Kidney Disease Improving Global Outcome

AKIN:

Acute Kidney Injury Network

PICARD:

Program to Improve Care of Renal Disease

ARDS:

Acute respiratory distress syndrome

ECMO:

Extracorporeal membrane oxygenation

PALICC:

Pediatric Acute Lung Injury Consensus Conference

CVVHDF:

Continuous veno-venous hemodiafiltration

HUDERF:

Hôpital Universitaire des Enfants Reine Fabiola

VV-ECMO:

Veno-venous extracorporeal membrane oxygenation

TBW:

Total body water

ICCA:

Intellispace Critical Care and Anesthesia

PIM:

Pediatric index of mortality

PRISM:

Pediatric risk mortality

PELOD:

Pediatric logistic organ dysfunction

P-PREP:

Pediatric Pulmonary Rescue with Extracorporeal Membrane Oxygenation Prediction

LIS:

Lung injury score

VIS:

Vasoactive-inotropic score

References

  1. Selewski DT, Cornell TT, Lombel RM, Blatt NB, Han YY, Mottes T, Kommareddi M, Kershaw DB, Shanley TP, Heung M (2011) Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 37:1166–1173

    Article  CAS  Google Scholar 

  2. Bouchard J, Macedo E, Soroko S, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, Program to Improve Care in Acute Renal Disease (2010) Comparison of methods for estimating glomerular filtration rate in critically ill patients with acute kidney injury. Nephrol Dial Transplant 25:102–107

    Article  Google Scholar 

  3. Bjornsson TD (1979) Use of serum creatinine concentrations to determine renal function. Clin Pharmacokinet 4:200–222

    Article  CAS  Google Scholar 

  4. Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, Program to Improve Care in Acute Renal Disease Study (2010) Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care 14:R82

    Article  Google Scholar 

  5. Liu KD, Thompson BT, Ancukiewicz M, Steingrub JS, Douglas IS, Matthay MA, Wright P, Peterson MW, Rock P, Hyzy RC, Anzueto A, Truwit JD, National Institutes of Health National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network (2011) Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes. Crit Care Med 39:2665–2671

    Article  Google Scholar 

  6. Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, Macleod A (2007) Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 18:1292–1298

    Article  CAS  Google Scholar 

  7. Ricci Z, Cruz D, Ronco C (2008) The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int 73:538–546

    Article  CAS  Google Scholar 

  8. Basu RK, Andrews A, Krawczeski C, Manning P, Wheeler DS, Goldstein SL (2013) Acute kidney injury based on corrected serum creatinine is associated with increased morbidity in children following the arterial switch operation. Pediatr Crit Care Med 14:e218-224

    Article  Google Scholar 

  9. Pediatric Acute Lung Injury Consensus Conference Group (2015) Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 16:428–439

    Article  Google Scholar 

  10. Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–184. https://doi.org/10.1159/000339789

  11. Wells JCK, Davies PSW, Fewtrell MS, Cole TJ (2020) Body composition reference charts for UK infants and children aged 6 weeks to 5 years based on measurement of total body water by isotope dilution. Eur J Clin Nutr 74:141–148

    Article  Google Scholar 

  12. Gist KM, Selewski DT, Brinton J, Menon S, Goldstein SL, Basu RK (2020) Assessment of the independent and synergistic effects of fluid overload and acute kidney injury on outcomes of critically ill children. Pediatr Crit Care Med 21:170–177

    Article  Google Scholar 

  13. Anderson HL 3rd, Coran AG, Drongowski RA, Ha HJ, Bartlett RH (1992) Extracellular fluid and total body water changes in neonates undergoing extracorporeal membrane oxygenation. J Pediatr Surg 27:1003–1007 (discussion 1007-1008)

  14. Gbadegesin R, Zhao S, Charpie J, Brophy PD, Smoyer WE, Lin JJ (2009) Significance of hemolysis on extracorporeal life support after cardiac surgery in children. Pediatr Nephrol 24:589–595

    Article  Google Scholar 

  15. Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, Hackbarth R, Somers MJ, Baum M, Symons JM, Flores FX, Benfield M, Askenazi D, Chand D, Fortenberry JD, Mahan JD, McBryde K, Blowey D, Goldstein SL (2010) Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 55:316–325

    Article  Google Scholar 

  16. He P, Zhang S, Hu B, Wu W (2018) Retrospective study on the effects of the prognosis of patients treated with extracorporeal membrane oxygenation combined with continuous renal replacement therapy. Ann Transl Med 6:455

    Article  CAS  Google Scholar 

  17. Schmidt M, Bailey M, Kelly J, Hodgson C, Cooper DJ, Scheinkestel C, Pellegrino V, Bellomo R, Pilcher D (2014) Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation. Intensive Care Med 40:1256–1266

    Article  CAS  Google Scholar 

  18. Extracorporeal Life Support Organization (2017) ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Version 1.4. Ann Arbor

  19. Fomon SJ, Haschke F, Ziegler EE, Nelson SE (1982) Body composition of reference children from birth to age 10 years. Am J Clin Nutr 35:1169–1175

    Article  CAS  Google Scholar 

  20. Haschke F, Fomon SJ, Ziegler EE (1981) Body composition of a nine-year-old reference boy. Pediatr Res 15:847–849

    Article  CAS  Google Scholar 

  21. Pepi M, Marenzi GC, Agostoni PG, Doria E, Barbier P, Muratori M, Celeste F, Guazzi MD (1993) Sustained cardiac diastolic changes elicited by ultrafiltration in patients with moderate congestive heart failure: pathophysiological correlates. Br Heart J 70:135–140

    Article  CAS  Google Scholar 

  22. Agostoni P, Marenzi G, Lauri G, Perego G, Schianni M, Sganzerla P, Guazzi MD (1994) Sustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: failure of furosemide to provide the same result. Am J Med 96:191–199

  23. Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, Jaski BE, Fang JC, Feller ED, Haas GJ, Anderson AS, Schollmeyer MP, Sobotka PA; UNLOAD  Trial Investigators (2007) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675–683

    Article  CAS  Google Scholar 

  24. Bart BA, Boyle A, Bank AJ, Anand I, Olivari MT, Kraemer M, Mackedanz S, Sobotka PA, Schollmeyer M, Goldsmith SR (2005) Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol 46:2043–2046

    Article  Google Scholar 

  25. Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R (2001) Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 107:1309–1312

    Article  CAS  Google Scholar 

  26. Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, Rogers K, Reid C, Tanner AJ, Easley KA (2004) Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med 32:1771–1776

    Article  Google Scholar 

  27. Selewski DT, Cornell TT, Blatt NB, Han YY, Mottes T, Kommareddi M, Gaies MG, Annich GM, Kershaw DB, Shanley TP, Heung M (2012) Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med 40:2694–2699

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank Dr. Melissa Jackson and Dr. Miguel Tavares for reviewing our manuscript.

Author information

Authors and Affiliations

  1. Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

    Sébastien Redant, David De Bels, Jacques Massaut & Patrick M. Honoré

  2. Department of Intensive Care, Hôpital Universitaire Des Enfants (HUDERF), Université Libre de Bruxelles (ULB), Brussels, Belgium

    Sébastien Redant, Océane Barbance & Dominique Biarent

  3. Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

    Fabio S. Taccone

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  1. Sébastien Redant
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Contributions

SR, DB designed the paper. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Sébastien Redant.

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Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Hôpital Universitaire des Enfants Reine Fabiola Brussels under the reference Dossier CE 116/18.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Redant, S., De Bels, D., Barbance, O. et al. Creatinine correction to account for fluid overload in children with acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: an initial exploratory report. Pediatr Nephrol 37, 891–898 (2022). https://doi.org/10.1007/s00467-021-05257-8

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  • DOI: https://doi.org/10.1007/s00467-021-05257-8

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