Skip to main content

Baseline creatinine determination method impacts association between acute kidney injury and clinical outcomes

Abstract

Background

Current consensus definition for acute kidney injury (AKI) does not specify how baseline serum creatinine should be determined. We assessed how baseline determination impacted AKI incidence and association between AKI and clinical outcomes.

Methods

We retrospectively applied empirical (measured serum creatinine) and imputed (age/height) baseline estimation methods to pediatric patients discharged between 2014 and 2019 from an academic hospital. Using each method, we estimated AKI incidence and assessed area under ROC curve (AUROC) for AKI as a predictor of three clinical outcomes: application of AKI billing code (proxy for more clinically overt disease), inpatient mortality, and post-hospitalization chronic kidney disease.

Results

Incidence was highly variable across baseline methods (12.2–26.7%). Incidence was highest when lowest pre-admission creatinine was used if available and Schwartz bedside equation was used to impute one otherwise. AKI was more predictive of application of an AKI billing code when baseline was imputed universally, regardless of pre-admission values (AUROC 80.7–84.9%) than with any empirical approach (AUROC 64.5–76.6%). AKI was predictive of post-hospitalization CKD when using universal imputation baseline methods (AUROC 67.0–74.6%); AKI was not strongly predictive of post-hospitalization CKD when using empirical baseline methods (AUROC 46.4–58.5%). Baseline determination method did not affect the association between AKI and inpatient mortality.

Conclusions

Method of baseline determination influences AKI incidence and association between AKI and clinical outcomes, illustrating the need for standard criteria. Imputing baseline for all patients, even when preadmission creatinine is available, may identify a more clinically relevant subset of the disease.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Data and materials

Not applicable.

References

  1. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL (2017) Epidemiology of acute kidney injury in critically Ill children and young adults. N Engl J Med 376:11–20. https://doi.org/10.1056/NEJMoa1611391

    Article  PubMed  Google Scholar 

  2. Coca SG, Singanamala S, Parikh CR (2012) Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 81:442–448. https://doi.org/10.1038/ki.2011.379

    Article  PubMed  Google Scholar 

  3. Sutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, Ling XB (2013) AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol 8:1661–1669. https://doi.org/10.2215/CJN.00270113

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, Goldstein SL (2015) AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 10:554–561. https://doi.org/10.2215/CJN.01900214

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, Edipidis K, Forni LG, Gomersall CD, Govil D, Honoré PM, Joannes-Boyau O, Joannidis M, Korhonen AM, Lavrentieva A, Mehta RL, Palevsky P, Roessler E, Ronco C, Uchino S, Vazquez JA, Vidal Andrade E, Webb S, Kellum JA (2015) Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 41:1411–1423. https://doi.org/10.1007/s00134-015-3934-7

    Article  PubMed  Google Scholar 

  6. Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO Clinical Practice Guideline for acute kidney injury. Kidney Int Suppl 2:1–138. https://doi.org/10.1038/kisup.2012.1

    Article  Google Scholar 

  7. Siew ED, Matheny ME (2015) Choice of reference serum creatinine in defining acute kidney injury. Nephron 131:107–112. https://doi.org/10.1159/000439144

    CAS  Article  PubMed  Google Scholar 

  8. Siew ED, Matheny ME, Ikizler TA, Lewis JB, Miller RA, Waitman LR, Go AS, Parikh CR, Peterson JF (2010) Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury. Kidney Int 77:536–542. https://doi.org/10.1038/KI.2009.479

    Article  PubMed  Google Scholar 

  9. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637. https://doi.org/10.1681/ASN.2008030287

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL (2008) Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol 3:948–954. https://doi.org/10.2215/CJN.05431207

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pottel H, Hoste L, Martens F (2012) A simple height-independent equation for estimating glomerular filtration rate in children. Pediatr Nephrol 27:973–979. https://doi.org/10.1007/s00467-011-2081-9

    Article  PubMed  Google Scholar 

  12. Hoste L, Dubourg L, Selistre L, De Souza VC, Ranchin B, Hadj-Aïssa A, Cochat P, Martens F, Pottel H (2014) A new equation to estimate the glomerular filtration rate in children, adolescents and young adults. Nephrol Dial Transplant 29:1082–1091. https://doi.org/10.1093/ndt/gft277

    CAS  Article  PubMed  Google Scholar 

  13. Russell WA, Scheinker D, Sutherland SM (2020) Code repository for baseline creatinine determination method impacts association between acute kidney injury and clinical outcomes. Zenodo. https://doi.org/10.5281/zenodo.4068594

  14. Kellum JA, Sileanu FE, Murugan R, Lucko N, Shaw AD, Clermont G (2015) Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol 26:2231–2238. https://doi.org/10.1681/ASN.2014070724

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Kaddourah A, Basu RK, Goldstein SL, Sutherland SM (2019) Oliguria and acute kidney injury in critically ill children: Implications for diagnosis and outcomes. Pediatr Crit Care Med 20:332–339. https://doi.org/10.1097/PCC.0000000000001866

    Article  PubMed  Google Scholar 

  16. Waikar SS, Wald R, Chertow GM, Curhan GC, Winkelmayer WC, Liangos O, Sosa MA, Jaber BL (2006) Validity of International Classification of Diseases, Ninth Revision? Clinical modification codes for acute renal failure. J Am Soc Nephrol 17:1688–1694. https://doi.org/10.1681/ASN.2006010073

    Article  PubMed  Google Scholar 

  17. Vlasschaert ME, Bejaimal SA, Hackam DG, Quinn R, Cuerden MS, Oliver MJ, Iansavichus A, Sultan N, Mills A, Garg AX (2011) Validity of administrative database coding for kidney disease: a systematic review. Am J Kidney Dis 57:29–43. https://doi.org/10.1053/j.ajkd.2010.08.031

    Article  PubMed  Google Scholar 

  18. Siew ED, Basu RK, Wunsch H, Shaw AD, Goldstein SL, Ronco C, Kellum JA, Bagshaw SM, 15th ADQI Consensus Group (2016) Optimizing administrative datasets to examine acute kidney injury in the era of big data: Workgroup statement from the 15th ADQI Consensus Conference. Can J Kidney Health Dis 3:12. https://doi.org/10.1186/s40697-016-0098-5

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hessey E, Ali R, Dorais M, Morissette G, Pizzi M, Rink N, Jouvet P, Lacroix J, Phan V, Zappitelli M (2017) Evaluation of height-dependent and height-independent methods of estimating baseline serum creatinine in critically ill children. Pediatr Nephrol 32:1953–1962. https://doi.org/10.1007/s00467-017-3670-z

    Article  PubMed  Google Scholar 

  20. Sutherland SM, Goldstein SL, Bagshaw SM (2018) Acute kidney injury and big data. Contrib Nephrol 193:55–67. https://doi.org/10.1159/000484963

    Article  PubMed  Google Scholar 

  21. Sutherland SM, Goldstein SL, Bagshaw SM (2017) Leveraging big data and electronic health records to enhance novel approaches to acute kidney injury research and care. Blood Purif 44:68–76. https://doi.org/10.1159/000458751

    Article  PubMed  Google Scholar 

  22. Nelson RG, Grams ME, Ballew SH, Sang Y, Azizi F, Chadban SJ, Chaker L, Dunning SC, Fox C, Hirakawa Y, Iseki K, Ix J, Jafar TH, Köttgen A, DMJ N, Ohkubo T, Prescott GJ, Rebholz CM, Sabanayagam C, Sairenchi T, Schöttker B, Shibagaki Y, Tonelli M, Zhang L, Gansevoort RT, Matsushita K, Woodward M, Coresh J, Shalev V, CKD Prognosis Consortium (2019) Development of risk prediction equations for incident chronic kidney disease. JAMA 322:2104–2014. https://doi.org/10.1001/jama.2019.17379

    Article  PubMed Central  PubMed  Google Scholar 

  23. Hessey E, Perreault S, Dorais M, Roy L, Zappitelli M (2019) Acute kidney injury in critically Ill children and subsequent chronic kidney disease. Can J Kidney Health Dis 6:2054358119880188. https://doi.org/10.1177/2054358119880188

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hsu RK, Hsu CY (2016) The role of acute kidney injury in chronic kidney disease. Semin Nephrol 36:283–292. https://doi.org/10.1016/j.semnephrol.2016.05.005

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sigurjonsdottir VK, Chaturvedi S, Mammen C, Sutherland SM (2018) Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm? Pediatr Nephrol 33:2047–2055. https://doi.org/10.1007/s00467-017-3870-6

Download references

Author information

Authors and Affiliations

Authors

Contributions

WAR collected and analyzed the data and drafted and revised the manuscript. SMS conceived of the analysis, advised on methods, and critically revised the manuscript. DS advised on methods and critically revised the manuscript.

Corresponding author

Correspondence to Scott M. Sutherland.

Ethics declarations

Conflict of interest

DS is an advisor to Carta Healthcare, a healthcare analytics company. WAR and SMS report no relevant conflicts of interest.

Ethics/consent

Research using retrospective patient data was obtained through routine care performed with waiver of consent.

Code availability

Upon acceptance, we will upload all code to an open, DOI-indexed online repository.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 1724 kb).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Russell, W.A., Scheinker, D. & Sutherland, S.M. Baseline creatinine determination method impacts association between acute kidney injury and clinical outcomes. Pediatr Nephrol 36, 1289–1297 (2021). https://doi.org/10.1007/s00467-020-04789-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-020-04789-9

Keywords

  • Acute kidney injury
  • AKI
  • Children
  • Serum creatinine
  • Epidemiology