Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort

for the Neonatal Kidney Collaborative

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)329-338
Number of pages10
JournalPediatric Research
Volume85
Issue number3
DOIs
StatePublished - Feb 1 2019
Externally publishedYes

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Acute Kidney Injury
Creatinine
Epidemiology
Newborn Infant
Serum
Gestational Age
Area Under Curve
Mortality
Age Groups
Kidney

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort. / for the Neonatal Kidney Collaborative.

In: Pediatric Research, Vol. 85, No. 3, 01.02.2019, p. 329-338.

Research output: Contribution to journalArticle

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title = "Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort",
abstract = "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.",
author = "{for the Neonatal Kidney Collaborative} and David Askenazi and Carolyn Abitbol and Louis Boohaker and Russell Griffin and Rupesh Raina and Joshua Dower and Davis, {T. Keefe} and Ray, {Patricio E.} and Sofia Perazzo and Marissa DeFreitas and Lawrence Milner and Namasivayam Ambalavanan and Cole, {F. Sessions} and Erin Rademacher and Michael Zappitelli and Maroun Mhanna and Selewski, {David T.} and Subrata Sarkar and Alison Kent and Jeffery Fletcher and Shahnaz Duara and Charlton, {Jennifer R.} and Swanson, {Jonathan R.} and Ronnie Guillet and Carl D’Angio and Ayesa Mian and Deepak Kumar and Jetton, {Jennifer G.} and Brophy, {Patrick D.} and Colaizy, {Tarah T.} and Klein, {Jonathan M.} and Arikan, {Ayse Akcan} and Rhee, {Christopher J.} and Goldstein, {Stuart L.} and Nathan, {Amy T.} and Kupferman, {Juan C.} and Alok Bhutada and Shantanu Rastogi and Elizabeth Bonachea and John Mahan and Alexandra Smith and Mamta Fuloria and Reidy, {Kimberly J.} and Kaskel, {Frederick J.} and Soranno, {Danielle E.} and Jason Gien and Gist, {Katja M.} and Chishti, {Aftab S.} and Hanna, {Mina H.} and Sangeeta Hingorani",
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doi = "10.1038/s41390-018-0249-8",
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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 J.

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

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 -