Abstract
Background
Pediatric acute kidney injury (AKI) is associated with long-term morbidity and mortality; however, outcomes improve when AKI is detected earlier. Current definitions of AKI use baseline creatinine; community-acquired AKI (CA-AKI) is difficult to define and detect in the pediatric emergency department (ED) when no baseline creatinine is available. Our objective was to compare age- and gender-based creatinine norms to the traditional baseline (lowest creatinine in previous 3 months) to diagnose CA-AKI.
Methods
This was a retrospective cross-sectional study conducted in children 1 month–18 years of age seen in the pediatric ED in whom a creatinine was obtained.
Results
Per the Kidney Disease Improving Global Outcomes AKI definition in encounters with baseline creatinine available, 343/2338 (14.7%) had CA-AKI. When the upper limit of the age- and gender-based creatinine norm was applied as a surrogate baseline creatinine, CA-AKI was diagnosed in 1.5% of encounters (239/15,486). Additionally, CA-AKI was diagnosed in 178 cases using the upper limit of age- and gender-based creatinine norms only, as these cases did not have a baseline creatinine.
Conclusions
Age- and gender-based creatinine norms can be applied as a surrogate baseline to detect CA-AKI in all children regardless of whether baseline creatinine is available, potentially detecting it earlier.
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E.R.O. designed the study, collected, reviewed, and analyzed data, performed statistical analysis, crafted the manuscript, and critically revised the manuscript. A.T.C. designed the study, performed statistical analysis, and critically revised the manuscript. G.J.B. designed the study, collected, reviewed and analyzed data, and revised the manuscript. L.M. and H.E.S. collected, reviewed and analyzed data, and revised the manuscript. S.D. designed the study and revised the manuscript. L.L.L. designed the study and critically revised the manuscript. A.A.A. designed the study, reviewed and analyzed data, performed statistical analysis, and critically revised the manuscript.
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A.A.A. has consulted for Baxter and receives research funding from NIAID. The other authors declare no competing interests.
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O’Neil, E.R., Devaraj, S., Mayorquin, L. et al. Defining pediatric community-acquired acute kidney injury: an observational study. Pediatr Res 87, 564–568 (2020). https://doi.org/10.1038/s41390-019-0577-3
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DOI: https://doi.org/10.1038/s41390-019-0577-3
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