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Assessment of the renal angina index for the prediction of acute kidney injury in patients admitted to a European pediatric intensive care unit

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Abstract

Background

Acute kidney injury (AKI) is associated with worse outcomes and increased morbidity and mortality in pediatric intensive care unit (PICU) patients. The renal angina index (RAI) has been proposed as an early prediction tool for AKI development.

Objectives

The objective was to evaluate outcomes of RAI-positive patients and to compare RAI performance with traditional AKI markers across different patient groups (medical/post-surgical). This was an observational retrospective study. All children admitted to a tertiary hospital PICU over a 3-year period were included. Electronic medical records were reviewed. Day 1 RAI was calculated, as was the presence and staging of day 3 AKI.

Results

A total of 593 patients were included; 56% were male, the mean age was 55 months, and 17% had a positive RAI. This was associated with day 3 AKI development and worse outcomes, such as greater need for kidney replacement therapy, longer duration of mechanical ventilation, vasoactive support and PICU stay, and higher mortality. For all-stage kidney injury, RAI presented a sensitivity of 87.5% and a specificity of 88.1%. Prediction of day 3 all-stage AKI by RAI had an AUC=0.878; its performance increased for severe AKI (AUC = 0.93). RAI was superior to serum creatinine increase and KDIGO AKI staging on day 1 in predicting severe AKI development. The performance remained high irrespective of the type of admission.

Conclusions

The RAI is a simple and inexpensive tool that can be used with medical and post-surgical PICU patients to predict AKI development and anticipate complications, allowing for the adoption of preventive measures.

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Availability of data and material

The data that support the findings of this study are available from Centro Hospitalar e Universitário de São João, with restricted access due to patient privacy. The authors had access to these data after a reasonable request and authorization from the referred institution.

Code availability

Not applicable.

Abbreviations

AKI:

Acute kidney injury

KDIGO:

Kidney Disease Improving Global Outcomes criteria staging

LOS:

Length of stay

PICU:

Pediatric intensive care unit

KRT:

Kidney replacement therapy

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Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal

    Francisco Ribeiro-Mourão, Ana Carvalho Vaz, Marta João Silva & Augusto Ribeiro

  2. Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal

    Francisco Ribeiro-Mourão, Ana Carvalho Vaz & André Azevedo

  3. Pediatrics Department, Pediatric Nephrology Unit, Centro Hospitalar e Universitário de São João, Porto, Portugal

    Helena Pinto & Joana Jardim

  4. Obstetrics & Gynecology Department and Paediatrics Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

    Marta João Silva

Authors
  1. Francisco Ribeiro-Mourão
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  2. Ana Carvalho Vaz
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  3. André Azevedo
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  7. Augusto Ribeiro
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Contributions

Conceptualization: Francisco Ribeiro-Mourão, Ana Carvalho Vaz, André Azevedo, Helena Pinto, Marta João Silva, Joana Jardim, Augusto Ribeiro. Methodology: Francisco Ribeiro-Mourão, Joana Jardim, Helena Pinto, Marta João Silva. Formal analysis and investigation: Francisco Ribeiro-Mourão, Ana Carvalho Vaz, André Azevedo, Joana Jardim. Writing - original draft preparation: Francisco Ribeiro-Mourão, Ana Carvalho Vaz, André Azevedo. Writing - review and editing: Francisco Ribeiro-Mourão, Ana Carvalho Vaz, André Azevedo, Helena Pinto, Marta João Silva, Joana Jardim, Augusto Ribeiro. Supervision: Joana Jardim, Augusto Ribeiro. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Francisco Ribeiro-Mourão.

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Ethics approval

Approval was obtained from the ethics committee of Centro Hospitalar e Universitário São João. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Waived by ethics committee

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The authors declare no competing interests.

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Ribeiro-Mourão, F., Vaz, A.C., Azevedo, A. et al. Assessment of the renal angina index for the prediction of acute kidney injury in patients admitted to a European pediatric intensive care unit. Pediatr Nephrol 36, 3993–4001 (2021). https://doi.org/10.1007/s00467-021-05116-6

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  • DOI: https://doi.org/10.1007/s00467-021-05116-6

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