Ascertainment and Epidemiology of Acute Kidney Injury Varies with Definition Interpretation

@article{citeulike:2964460, abstract = {Background and objectives: Differences in defining acute kidney injury (AKI) may impact incidence ascertainment. We assessed the effects of different AKI definition interpretation methods on epidemiology ascertainment. Design, setting, participants, \& measurements: Two groups were studied at Texas Children's Hospital, Houston, Texas: 150 critically ill children (prospective) and 254 noncritically ill, hospitalized children receiving aminoglycosides (retrospective). SCr was collected for 14 d in the prospective study and 21 d in the retrospective study. Children with known baseline serum creatinine (bSCr) were classified by the pediatric Risk, Injury, Failure, Loss, End-Stage Kidney Disease (pRIFLE) AKI definition using SCr change (pRIFLE{Delta}SCr), estimated creatinine clearance (eCCl) change (pRIFLE{Delta}CCl), and the Acute Kidney Injury Network (AKIN) definition. In subjects without known bSCr, bSCR was estimated as eCCl = 100 (eCCl100) and 120 ml/min per 1.73 m2 (eCCl120), admission SCr (AdmSCr) and lower/upper normative values (NormsMin, NormsMax). The differential impact of each AKI definition interpretation on incidence estimation and severity distribution was evaluated. Results: pRIFLE{Delta}SCr and AKIN led to identical AKI distributions. pRIFLE{Delta}CCl resulted in 14.5\% (critically ill) and 11\% (noncritical) more patients diagnosed with AKI compared to other methods (P 0.05). Different bSCr estimates led to differences in AKI incidence, from 12\% (AdmSCr) to 87.8\% (NormsMin) (P 0.05) in the critically ill group and from 4.6\% (eCCl100) to 43.1\% (NormsMin) (P 0.05) in the noncritical group. Conclusions: AKI definition variation causes interstudy heterogeneity. AKI definition should be standardized so that results can be compared across studies. 10.2215/CJN.05431207}, author = {Zappitelli, Michael and Parikh, Chirag R. and Akcan-Arikan, Ayse and Washburn, Kimberley K. and Moffett, Brady S. and Goldstein, Stuart L. }, citeulike-article-id = {2964460}, doi = {10.2215/CJN.05431207}, journal = {Clin J Am Soc Nephrol}, keywords = {arf}, month = {July}, number = {4}, pages = {948--954}, posted-at = {2008-07-04 15:16:44}, priority = {2}, title = {Ascertainment and Epidemiology of Acute Kidney Injury Varies with Definition Interpretation}, url = {http://dx.doi.org/10.2215/CJN.05431207}, volume = {3}, year = {2008} }

TY - JOUR ID - citeulike:2964460 L3 - citeulike-article-id:2964460 TI - Ascertainment and Epidemiology of Acute Kidney Injury Varies with Definition Interpretation JF - Clin J Am Soc Nephrol VL - 3 IS - 4 SP - 948 EP - 954 N2 - Background and objectives: Differences in defining acute kidney injury (AKI) may impact incidence ascertainment. We assessed the effects of different AKI definition interpretation methods on epidemiology ascertainment. Design, setting, participants, & measurements: Two groups were studied at Texas Children's Hospital, Houston, Texas: 150 critically ill children (prospective) and 254 noncritically ill, hospitalized children receiving aminoglycosides (retrospective). SCr was collected for 14 d in the prospective study and 21 d in the retrospective study. Children with known baseline serum creatinine (bSCr) were classified by the pediatric Risk, Injury, Failure, Loss, End-Stage Kidney Disease (pRIFLE) AKI definition using SCr change (pRIFLE{Delta}SCr), estimated creatinine clearance (eCCl) change (pRIFLE{Delta}CCl), and the Acute Kidney Injury Network (AKIN) definition. In subjects without known bSCr, bSCR was estimated as eCCl = 100 (eCCl100) and 120 ml/min per 1.73 m2 (eCCl120), admission SCr (AdmSCr) and lower/upper normative values (NormsMin, NormsMax). The differential impact of each AKI definition interpretation on incidence estimation and severity distribution was evaluated. Results: pRIFLE{Delta}SCr and AKIN led to identical AKI distributions. pRIFLE{Delta}CCl resulted in 14.5% (critically ill) and 11% (noncritical) more patients diagnosed with AKI compared to other methods (P 0.05). Different bSCr estimates led to differences in AKI incidence, from 12% (AdmSCr) to 87.8% (NormsMin) (P 0.05) in the critically ill group and from 4.6% (eCCl100) to 43.1% (NormsMin) (P 0.05) in the noncritical group. Conclusions: AKI definition variation causes interstudy heterogeneity. AKI definition should be standardized so that results can be compared across studies. 10.2215/CJN.05431207 KW - arf AU - Zappitelli, Michael AU - Parikh, Chirag AU - Akcan-Arikan, Ayse AU - Washburn, Kimberley AU - Moffett, Brady AU - Goldstein, Stuart PY - 2008/07/01/ UR - http://dx.doi.org/10.2215/CJN.05431207 ER -