Pediatric Reference Change Value Optimized for Acute Kidney Injury: Multicenter Retrospective Study in China

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Clinical Epidemiology

Background:

• Pediatric acute kidney injury (AKI) definitions are evolving, particularly for critically ill children in pediatric intensive care units (PICUs).
• Existing criteria like Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) have limitations in this population.

Purpose of the Study:

• To validate the application of the Pediatric Reference Change Value Optimized for Acute Kidney Injury in Children (pROCK) criteria in critically ill children.
• To assess the correlation of pROCK with AKI severity, clinical parameters, and 90-day outcomes.

Main Methods:

• A multicenter retrospective study involving 1,678 hospitalized children admitted to six PICUs in mainland China.
• AKI diagnosis and staging using pRIFLE, KDIGO, and pROCK criteria.
• Analysis of clinical parameters, 90-day follow-up outcomes, and severity scores (e.g., PRISM III, P-LogD-2).

Main Results:

• The prevalence of AKI varied significantly: 52.8% by pRIFLE, 39.0% by KDIGO, and 19.0% by pROCK.
• pROCK-defined AKI correlated with increased organ injury, sepsis, mechanical ventilation, continuous renal replacement therapy, and higher mortality risk scores.
• pROCK criteria demonstrated better separation between AKI stages and non-AKI, and were associated with shorter 90-day survival time.

Conclusions:

• The pROCK criteria for AKI show a stronger correlation with the severity and outcomes of AKI in critically ill children compared to pRIFLE and KDIGO.
• The pROCK criteria may offer improved utility for diagnosing and staging AKI in the pediatric intensive care unit setting.