Ascertainment and epidemiology of acute kidney injury varies with definition interpretation

Michael Zappitelli, Chirag R. Parikh, Ayse Akcan-Arikan, Kimberly K. Washburn, Brady S. Moffett, Stuart L. Goldstein

Research output: Contribution to journalArticlepeer-review


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 (pRIFLEΔSCr), estimated creatinine clearance (eCCl) change (pRIFLEΔCCl), 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: pRIFLEΔSCr and AKIN led to identical AKI distributions. pRIFLEΔCCl 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.

Original languageEnglish (US)
Pages (from-to)948-954
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Issue number4
StatePublished - Jul 2008
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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