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Consensus acute kidney injury criteria integration identifies children at risk for long-term kidney dysfunction after multiple organ dysfunction syndrome

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Abstract

Background

The consensus definition of acute kidney injury (AKI) has evolved since developing the original multiple organ dysfunction syndrome (MODS) definitions. Whether or not risk for adverse short- and long-term outcomes can be identified using the refined AKI criteria in the setting of MODS has not been studied. We hypothesize that incorporation of Kidney Disease: Improving Global Outcome (KDIGO) AKI criteria into existing MODS definitions will have a higher association with major adverse kidney events at 30 days (MAKE30) and will increase the number of patients with MODS.

Methods

Post hoc analysis of 410 children admitted to a tertiary care pediatric intensive care unit (PICU) was conducted. MODS was defined using two existing criteria (Goldstein and Proulx) during the first 7 days following ICU admission and then modified by replacement of the kidney injury criteria using the KDIGO AKI definitions (G′ and P′).

Results

MAKE30 occurred in 65 of 410 (16%) children. After substituting KDIGO kidney injury criteria, identification of MAKE30 increased from 46 children (71%) to 53 (82%) and 29 children (45%) to 43 (66%) for the Goldstein and Proulx criteria, respectively. Additionally, identification of MODS increased from 194 (47%) by Goldstein to 224 (55%) by G′ and 95 children (23%) by Proulx to 132 (32%) by P′.

Conclusions

Substituting KDIGO AKI criteria into existing MODS criteria increases the sensitivity for major adverse kidney events as well as the identification of MODS, improving the detection of children at risk for long-term adverse renal outcomes.

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Authors and Affiliations

  1. Department of Pediatrics, University of Michigan Medical School, 1500 E. Medical Center Drive, F-6890, Ann Arbor, MI, 48109, USA

    Stephen M. Gorga, Erin F. Carlton, Joseph G. Kohne & Ryan P. Barbaro

  2. Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA

    Erin F. Carlton, Joseph G. Kohne & Ryan P. Barbaro

  3. Children’s Healthcare of Atlanta/Emory University, Atlanta, GA, USA

    Rajit K. Basu

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  1. Stephen M. Gorga
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Gorga, S.M., Carlton, E.F., Kohne, J.G. et al. Consensus acute kidney injury criteria integration identifies children at risk for long-term kidney dysfunction after multiple organ dysfunction syndrome. Pediatr Nephrol 36, 1637–1646 (2021). https://doi.org/10.1007/s00467-020-04865-0

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