TY - JOUR
T1 - Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort
AU - for the Neonatal Kidney Collaborative
AU - Askenazi, David
AU - Abitbol, Carolyn
AU - Boohaker, Louis
AU - Griffin, Russell
AU - Raina, Rupesh
AU - Dower, Joshua
AU - Davis, T. Keefe
AU - Ray, Patricio E.
AU - Perazzo, Sofia
AU - DeFreitas, Marissa
AU - Milner, Lawrence
AU - Ambalavanan, Namasivayam
AU - Cole, F. Sessions
AU - Rademacher, Erin
AU - Zappitelli, Michael
AU - Mhanna, Maroun
AU - Selewski, David T.
AU - Sarkar, Subrata
AU - Kent, Alison
AU - Fletcher, Jeffery
AU - Duara, Shahnaz
AU - Charlton, Jennifer R.
AU - Swanson, Jonathan R.
AU - Guillet, Ronnie
AU - D’Angio, Carl
AU - Mian, Ayesa
AU - Kumar, Deepak
AU - Jetton, Jennifer G.
AU - Brophy, Patrick D.
AU - Colaizy, Tarah T.
AU - Klein, Jonathan M.
AU - Arikan, Ayse Akcan
AU - Rhee, Christopher J.
AU - Goldstein, Stuart L.
AU - Nathan, Amy T.
AU - Kupferman, Juan C.
AU - Bhutada, Alok
AU - Rastogi, Shantanu
AU - Bonachea, Elizabeth
AU - Mahan, John
AU - Smith, Alexandra
AU - Fuloria, Mamta
AU - Reidy, Kimberly
AU - Kaskel, Frederick J.
AU - Soranno, Danielle E.
AU - Gien, Jason
AU - Gist, Katja M.
AU - Chishti, Aftab S.
AU - Hanna, Mina H.
AU - Hingorani, Sangeeta
N1 - Funding Information:
Competing interests: All authors declare no real or perceived conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. For full disclosure, we provide here an additional list of other author’s commitments and funding sources that are not directly related to this study: David J Askenazi serves on the speaker board for Baxter (Baxter, USA), and the Acute Kidney Injury (AKI) Foundation (Cincinnati, OH, USA); he also receives grant funding for studies not related to this manuscript from National Institutes of Health—National Institutes of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK, R01 DK103608 and NIH-FDA, R01 FD005092). Jennifer G Jetton is supported by the University of Iowa Institute for Clinical and Translational Sciences NIH U54TR001356. Juan C. Kupferman is on the speaker’s Bureau and consultant for Alexion Pharmaceuticals. Robert Woroniecki is supported by the Department of Pediatrics at Stony Brook Children’s hospital (NY, USA). AWAKEN investigators at the Canberra Hospital were supported by the Canberra Hospital Private Practice fund, and investigators at University of Virginia Children’s Hospital were supported by a 100 Women Who Care Grant (100 Women Charitable Foundation, CA, USA).
Funding Information:
Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, for the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), as well as support for some of the AWAKEN investigators at UAB (L.B.J., R.J.G.). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB), and is funded by Children’s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Finally, the AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (CTSC, NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356). Funding sources for this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Publisher Copyright:
© 2019, International Pediatric Research Foundation, Inc.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Background: Neonates with serum creatinine (SCr) rise ≥0.3 mg/dL and/or ≥50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds. Methods: Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1–2 and ≥1 SCr on postnatal days 3–8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups. Results: The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 and ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity. Conclusion: Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.
AB - Background: Neonates with serum creatinine (SCr) rise ≥0.3 mg/dL and/or ≥50% SCr rise are more likely to die, even when controlling for confounders. These thresholds have not been tested in newborns. We hypothesized that different gestational age (GA) groups require different SCr thresholds. Methods: Neonates in Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) with ≥1 SCr on postnatal days 1–2 and ≥1 SCr on postnatal days 3–8 were assessed. We compared the mortality predictability of SCr absolute (≥0.3 mg/dL) vs percent (≥50%) rise. Next, we determine usefulness of combining absolute with percent rise. Finally, we determined the optimal absolute, percent, and maximum SCr thresholds that provide the highest mortality area under curve (AUC) and specificity for different GA groups. Results: The ≥0.3 mg/dL rise outperformed ≥50% SCr rise. Addition of percent rise did not improve mortality predictability. The optimal SCr thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks GA, and ≥0.1 and ≥0.3 mg/dL for >29 week GA. The maximum SCr value provides great specificity. Conclusion: Unique SCr rise cutoffs for different GA improves outcome prediction. Percent SCr rise does not add value to the neonatal AKI definition.
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U2 - 10.1038/s41390-018-0249-8
DO - 10.1038/s41390-018-0249-8
M3 - Article
C2 - 30643188
AN - SCOPUS:85059950208
VL - 85
SP - 329
EP - 338
JO - Pediatric Research
JF - Pediatric Research
SN - 0031-3998
IS - 3
ER -