Renal angina index in critically ill children as an applicable and reliable tool in the prediction of severe acute kidney injury: Two tertiary centers’ prospective observational study from the Middle East

Author:

Soliman Ahmed S.A.1,Al-Ghamdi Hamdan S.2,Abukhatwah Mohamed W.2,Kamal Nagla M.3,Dabour Shaheen A.1,Elgendy Soha A.1,Alfaifi Jaber4,Abukhatwah Omar M.W.5,Abosabie Salma A.S.6,Abosabie Sara A.7,Oshi Mohammed A.M.28,Althobaity Jwaher2,Sakr Sherbiny Hanan49,Al-Juaid Futun A.10,Rahman Eman G. Abdel1

Affiliation:

1. Pediatric Department, Faculty of Medicine, Benha University, Egypt

2. Pediatric Department, Al-Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia

3. Pediatric Department, Faculty of Medicine, Cairo University, Egypt

4. Department of Child Health, College of Medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia

5. Internal Medicine Department, College of Medicine, Alexandria University, Egypt

6. Medical Student, Faculty of Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany

7. Medical Student, Faculty of Medicine, Julius-Maximilians-Universität Würzburg, Bavaria, Germany

8. Neurology Division, Gaafar Ibnauf Children’s Emergency Hospital, Khartoum, Sudan

9. Pediatric Department, Zagazig University, Zagazig, Egypt

10. Pediatric Department, Taif Children Hospital, Taif, Kingdom of Saudi Arabia.

Abstract

Acute kidney damage (AKI) is a common cause of pediatric intensive care unit (PICU) admissions. Implementing a reno-protective strategy for AKI prediction can significantly enhance outcomes. The renal angina index (RAI) is a risk stratification tool used to predict severe AKI. We aim to assess the reliability and accuracy of the RAI scoring system in predicting AKI as compared to other conventional AKI markers. A prospective, observational study was conducted in the PICU of 2 tertiary medical centers in the Middle East. A total of 446 patients, aged 1-month to 14-years, without chronic kidney disease were enrolled. The RAI was calculated using the renal risk and renal injury score within the first 8 to 12 hours of admission. The accuracy of RAI was compared to changes in serum creatinine from baseline. The outcome was assessed on Day 3 for presence of AKI according to the kidney disease improving global outcome (KDIGO) criteria and associated sequelae. A positive RAI (RA+) was defined as RAI readings ≥ 8. Among the patients, 89 (19.9%) had a positive RAI within the first 8 to 12 hours of admission. The RA + group had a significantly higher occurrence of Day 3 severe AKI (KDIGO stages 2&3) compared to the RA− group (60.6% vs 4.2%, P < .001). The RA + group also had a significantly higher utilization of renal replacement therapy (RRT) (21.3% vs 1.1%, P < .001), longer mean PICU length of stay in days (11.1 ± 3.5 vs 5.5 ± 2.1, P < .001), and increased mortality (31.4% vs 2.8%, P < .001) compared to the RA− group. The RAI score demonstrated superior predictive ability for Day 3 AKI, with a sensitivity of 72%, specificity of 95%, and area under the curve (AUC) of 0.837, compared to changes in serum creatinine from baseline (sensitivity: 65%, specificity: 89%, AUC: 0.773), fluid overload (sensitivity: 43.7%, specificity: 79%, AUC: 0.613), and illness severity scores (sensitivity: 52.4%, specificity: 80.5%, AUC: 0.657). RAI proved to be a reliable and rapid bedside test for identifying critically ill children at risk of developing severe AKI. This enables physicians to implement reno-protective measures and intervene early, thereby improving prognosis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine

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