Related Experiment Video
Updated: Dec 4, 2025
Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice
Published on: August 9, 2013
Baseline creatinine determination method impacts association between acute kidney injury and clinical outcomes
W Alton Russell1, David Scheinker1,2,3,4, Scott M Sutherland5,6
1Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
Insights
Determining baseline serum creatinine significantly impacts acute kidney injury (AKI) detection and outcomes in children. Universal imputation may identify more clinically relevant AKI cases than empirical methods.
Area of Science:
- Pediatric Nephrology
- Clinical Chemistry
- Biomarker Discovery
Background:
- Current consensus definitions for acute kidney injury (AKI) lack standardized methods for determining baseline serum creatinine.
- This ambiguity affects the accurate assessment of AKI incidence and its clinical implications.
Purpose of the Study:
- To evaluate how different baseline serum creatinine determination methods influence AKI incidence in pediatric patients.
- To assess the impact of these methods on the association between AKI and clinical outcomes, including mortality and chronic kidney disease.
Main Methods:
- Retrospective analysis of pediatric patients discharged between 2014-2019.
- Application of empirical (measured creatinine) and imputed (age/height-based equations) baseline estimation methods.
- Assessment of AKI incidence and predictive accuracy (AUROC) for clinical outcomes: AKI billing code, inpatient mortality, and post-hospitalization CKD.
Main Results:
- AKI incidence varied substantially (12.2-26.7%) across baseline methods.
- Universal imputation of baseline creatinine improved AKI prediction for billing codes (AUROC 80.7-84.9%) compared to empirical methods (AUROC 64.5-76.6%).
- Universal imputation also enhanced AKI prediction for post-hospitalization CKD (AUROC 67.0-74.6%), while empirical methods showed weak association (AUROC 46.4-58.5%). Baseline method did not impact mortality prediction.
Conclusions:
- The method for determining baseline serum creatinine significantly influences AKI incidence and its association with clinical outcomes in pediatric patients.
- Standardized criteria for baseline determination are crucial for consistent AKI diagnosis and management.
- Universal imputation of baseline creatinine may identify a more clinically relevant AKI population, even when pre-admission values are available.
Background:
Current consensus definition for acute kidney injury (AKI) does not specify how baseline serum creatinine should be determined. We assessed how baseline determination impacted AKI incidence and association between AKI and clinical outcomes.
Methods:
We retrospectively applied empirical (measured serum creatinine) and imputed (age/height) baseline estimation methods to pediatric patients discharged between 2014 and 2019 from an academic hospital. Using each method, we estimated AKI incidence and assessed area under ROC curve (AUROC) for AKI as a predictor of three clinical outcomes: application of AKI billing code (proxy for more clinically overt disease), inpatient mortality, and post-hospitalization chronic kidney disease.
Results:
Incidence was highly variable across baseline methods (12.2-26.7%). Incidence was highest when lowest pre-admission creatinine was used if available and Schwartz bedside equation was used to impute one otherwise. AKI was more predictive of application of an AKI billing code when baseline was imputed universally, regardless of pre-admission values (AUROC 80.7-84.9%) than with any empirical approach (AUROC 64.5-76.6%). AKI was predictive of post-hospitalization CKD when using universal imputation baseline methods (AUROC 67.0-74.6%); AKI was not strongly predictive of post-hospitalization CKD when using empirical baseline methods (AUROC 46.4-58.5%). Baseline determination method did not affect the association between AKI and inpatient mortality.
Conclusions:
Method of baseline determination influences AKI incidence and association between AKI and clinical outcomes, illustrating the need for standard criteria. Imputing baseline for all patients, even when preadmission creatinine is available, may identify a more clinically relevant subset of the disease.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury III: Clinical Manifestations
01:25Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...