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Derivation and evaluation of baseline creatinine equations for hospitalized children and adolescents: the AKI baseline creatinine equation

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Abstract

Background

Acute kidney injury (AKI) definitions incorporate baseline creatinine (Crb) values, but Crb are frequently unknown in pediatrics. Our primary aim was to derive and validate a novel AKI Baseline Creatinine (ABC) estimation equation and compare it to existing methods of estimating Crb values.

Methods

We conducted a single-center retrospective analysis of pediatric patients (0–25 years) admitted from 2012 to 2019. Included patients required at least one outpatient Crb prior to hospitalization (gold standard). Novel equations were developed with demographic and initial creatinine data. Existing methods included back-calculating Crb based on Schwartz, Full Age Spectrum (FAS), and CKiD-under-25 (U25) equations. To determine an optimal equation, we compared novel and existing equations to the gold standard.

Results

The optimal simplified equation (ABC) included only age and had R2 = 59.9% and 73.2% of values within 30% of true Crb. The precision increased significantly when the equation included age and minimum creatinine within initial 72 h (ABC-cr): R2 = 75.4% and 86.5% of values within 30% of true Crb. The best performing existing equation was the age-based FAS, which had R2 = 61.0% and 78.0% of values within 30% of true Crb. All other existing equations performed worse, some methods as low as 52.6% within 30% of true Crb.

Conclusions

The newly derived ABC equation is simple, and the ABC-cr equation can more accurately estimate Crb by ≥ 25% compared to previous methods. The potential applicability of these equations is vast, including faster recognition of AKI on initial patient contact and improved standardization of pediatric AKI definitions, enhancing health services research.

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Acknowledgements

The authors wish to acknowledge the help of our research assistant, Scott House.

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Authors and Affiliations

  1. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    Chloe Braun & Eric Macomb

  2. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    A. K. M. Fazlur Rahman

  3. Division of Pediatric Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 516, Birmingham, AL, 35233, USA

    David Askenazi & Erica C. Bjornstad

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Correspondence to Erica C. Bjornstad.

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Conflict of interest

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: DA is a consultant for Baxter, Nuwellis, Medtronic Bioporto, the AKI Foundation, and SeaStar, and receives grant funding for education and studies not related to this project from Baxter, Nuwellis, and Medtronic.

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Braun, C., Rahman, A.K.M.F., Macomb, E. et al. Derivation and evaluation of baseline creatinine equations for hospitalized children and adolescents: the AKI baseline creatinine equation. Pediatr Nephrol 37, 3223–3233 (2022). https://doi.org/10.1007/s00467-022-05571-9

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  • DOI: https://doi.org/10.1007/s00467-022-05571-9

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