Optimization of Kidney Disease: Improving Global Outcomes Criteria for AKI for Pediatric Population
Chao Zhang1, Ruohua Yan1, Xiaohang Liu1
1Center for Clinical Epidemiology and Evidence-based Medicine, National Center for Children Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Insights
The new pediatric Kidney Disease: Improving Global Outcomes (pKDIGO) criteria accurately identify acute kidney injury (AKI) in children and predict in-hospital death better than existing methods.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Biomarkers of Kidney Injury
Background:
- Accurate detection and staging of acute kidney injury (AKI) are crucial for timely clinical management in children.
- Existing AKI criteria may not adequately account for age and sex-specific physiological differences in pediatric populations.
Purpose of the Study:
- To establish and validate a pediatric version of the Kidney Disease: Improving Global Outcomes (pKDIGO) criteria for diagnosing AKI in children.
- To compare the performance of pKDIGO with other pediatric AKI definitions in predicting in-hospital mortality.
Main Methods:
- Developed pKDIGO criteria by revising thresholds for serum creatinine and estimated GFR to exclude age and sex impacts.
- Compared pKDIGO with KDIGO, mKDIGO, pROCK, and pRIFLE using retrospective data from two large Chinese pediatric cohorts (Beijing Children's Hospital and Zhejiang University Children's Hospital ICUs).
- Evaluated diagnostic and prognostic performance using receiver operating characteristic curves (AUCs) for predicting in-hospital death.
Main Results:
- The study included 57,229 children in the Beijing Children's Hospital cohort and 8,276 in the ICU cohort.
- pKDIGO demonstrated superior performance in predicting mortality (AUC = 0.75) compared to other definitions in the Beijing Children's Hospital cohort.
- Increased AKI severity defined by pKDIGO correlated with a higher risk of death, consistent findings observed in the ICU cohort.
Conclusions:
- The pKDIGO criteria exhibit enhanced ability to identify pediatric patients with AKI.
- pKDIGO criteria show improved predictive power for in-hospital mortality in children across general wards and intensive care units.
Introduction:
Accurate detection and staging of acute kidney injury (AKI) is important in clinical practice to aid timely management. The main purpose of this study is to establish a pediatric version of Kidney Disease: Improving Global Outcomes (KDIGO, pKDIGO) criteria for pediatric population.
Methods:
The pKDIGO criteria defined AKI following the principles of KDIGO, in which the threshold of absolute increase in serum creatinine (SCr) or absolute decrease in estimated glomerular filtration rate (GFR, eGFR) to diagnose AKI has been revised to eliminate the impacts of age and sex of children. Then, AKI defined by pKDIGO were compared with that defined by KDIGO, modified KDIGO (mKDIGO), pediatric reference change value optimized for AKI in children (pROCK), and pediatric Risk for renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal disease (RIFLE, pRIFLE) based on 2 retrospective cohorts in China: Beijing Children's Hospital (BCH) cohort and intensive care units (ICUs) of the Children's Hospital of Zhejiang University School of Medicine (ICU) cohort. The performance of different AKI definitions was compared based on the area under the receiver operating characteristic curves (AUCs) for predicting the in-hospital death.
Results:
Total of 57,229 children in the BCH cohort and 8276 children in the ICU cohort were used to evaluate the performance of pKDIGO. In the BCH cohort, AUCs for predicting mortality by AKI defined based on pKDIGO (AUC = 0.75, 0.72-0.78) were higher than that defined by other definitions. The risk of death increases with higher stage of AKI defined by pKDIGO. Similar results were observed in the ICU cohort.
Conclusion:
The pKDIGO criteria showed a better ability to identify patients with AKI and predict in-hospital death in children, both in general wards and ICUs.
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