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Ascertainment and Epidemiology of Acute Kidney Injury Varies with Definition Interpretation

Michael Zappitelli^*, Chirag R. Parikh, Ayse Akcan-Arikan^*, Kimberley K. Washburn^*, Brady S. Moffett, and Stuart L. Goldstein^*

^* Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, Texas; Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut; and Department of Pharmacy, Texas Children's Hospital, Houston, Texas

Correspondence: Dr. Michael Zappitelli, Montreal Children's Hospital, 2300 Tupper, Room E-222, Montreal, QC, H3H 1P3, Canada. Phone: 514-412-4400, extension 22524; Fax: 514-412-4359; E-mail: mzaprdr{at}yahoo.ca

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_SCr), estimated creatinine clearance (eCCl) change (pRIFLE_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_SCr and AKIN led to identical AKI distributions. pRIFLE_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.