Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

David T. Selewski; Timothy T. Cornell; Michael Heung; Jonathan P. Troost; Brett J. Ehrmann; Rebecca M. Lombel; Neal B. Blatt; Kera Luckritz; Sue Hieber; Robert Gajarski; David B. Kershaw; Thomas P. Shanley; Debbie S. Gipson

doi:10.1007/s00134-014-3391-8

Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

David T. Selewski^*, Timothy T. Cornell, Michael Heung, Jonathan P. Troost, Brett J. Ehrmann, Rebecca M. Lombel, Neal B. Blatt, Kera Luckritz, Sue Hieber, Robert Gajarski, David B. Kershaw, Thomas P. Shanley, Debbie S. Gipson

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

181 Scopus citations

Abstract

Purpose: Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.

Methods: The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).

Results: AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).

Conclusions: Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.

Original language	English (US)
Pages (from-to)	1481-1488
Number of pages	8
Journal	Intensive Care Medicine
Volume	40
Issue number	10
DOIs	https://doi.org/10.1007/s00134-014-3391-8
State	Published - Sep 26 2014

Funding

Acknowledgments The authors wish to thank the Department of Pediatrics and Communicable Disease at the University of Michigan for supporting this project. The authors also wish to thank the Clinical Research Informatics Core within the Michigan Institute for Clinical and Health Research (supported by 2UL1TR000433), as well as the Honest Broker Office of the University of Michigan Medical School for their assistance with this work. This work was supported by a grant from the Renal Research Institute.

Keywords

Acute kidney injury
KDIGO
Pediatric cardiac intensive care
Pediatric intensive care

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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10.1007/s00134-014-3391-8

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Selewski, D. T., Cornell, T. T., Heung, M., Troost, J. P., Ehrmann, B. J., Lombel, R. M., Blatt, N. B., Luckritz, K., Hieber, S., Gajarski, R., Kershaw, D. B., Shanley, T. P., & Gipson, D. S. (2014). Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Medicine, 40(10), 1481-1488. https://doi.org/10.1007/s00134-014-3391-8

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abstract = "Purpose: Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.Methods: The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).Results: AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).Conclusions: Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.",

keywords = "Acute kidney injury, KDIGO, Pediatric cardiac intensive care, Pediatric intensive care",

author = "Selewski, {David T.} and Cornell, {Timothy T.} and Michael Heung and Troost, {Jonathan P.} and Ehrmann, {Brett J.} and Lombel, {Rebecca M.} and Blatt, {Neal B.} and Kera Luckritz and Sue Hieber and Robert Gajarski and Kershaw, {David B.} and Shanley, {Thomas P.} and Gipson, {Debbie S.}",

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AU - Selewski, David T.

AU - Cornell, Timothy T.

AU - Heung, Michael

AU - Troost, Jonathan P.

AU - Ehrmann, Brett J.

AU - Lombel, Rebecca M.

AU - Blatt, Neal B.

AU - Luckritz, Kera

AU - Hieber, Sue

AU - Gajarski, Robert

AU - Kershaw, David B.

AU - Shanley, Thomas P.

AU - Gipson, Debbie S.

PY - 2014/9/26

Y1 - 2014/9/26

N2 - Purpose: Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.Methods: The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).Results: AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).Conclusions: Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.

AB - Purpose: Acute kidney injury (AKI) occurs commonly in critically ill children and has been associated with increased mortality of up to 50 %. The Kidney Disease: Improving Global Outcomes (KDIGO) AKI working group has proposed a standardized definition of AKI. Utilizing routinely available clinical data, we evaluated the KDIGO AKI criteria and the relationship of AKI with relevant outcomes in a single center tertiary pediatric intensive care (PICU) and cardiac intensive care unit (CICU) population.Methods: The University of Michigan Pediatric Critical Care Database was probed for all discharges from the pediatric intensive care and cardiac intensive care units between July 2011 and October 2013 (N = 4,645). The KDIGO serum creatinine (SCr)-based criteria staged AKI with the modification that a minimum SCr of greater than 0.5 mg/dL was required to be classified as AKI. Exclusion: end-stage renal disease, new renal transplant, missing PRISM III data, or no measured Cr during intensive care unit (ICU) admission (N = 1,636).Results: AKI occurred in 737 (24.5 %, stage 1 = 193, stage 2 = 189, and stage 3 = 355) of 3,009 discharges (PICU N = 1,870, CICU N = 1,139) that included 2,415 patients. In multivariate analysis AKI was associated with increased ICU length of stay (LOS) in hours (stage I β = 42.2, p = 0.024, II β = 74.1, p = 0.003, III β = 215.8, p < 0.001). Multivariate analysis showed that AKI was associated with increased odds of ICU mortality (OR 3.4, 95 % CI 2.0–6.0) and increased length of mechanical ventilation among those requiring mechanical ventilation (β = 2.3 days, p < 0.001).Conclusions: Using the KDIGO criteria to define AKI, we observed a high prevalence of AKI among critically ill children. Worsening stages of AKI were associated with increased ICU LOS, and AKI was independently associated with prolonged mechanical ventilation and increased mortality. The KDIGO criteria describe clinically relevant AKI in a broad pediatric critical care population.

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KW - KDIGO

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Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population

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