Success of the acute renal angina index in the early prediction of acute kidney injury in the emergency department

ABSTRACT

Introduction

It is mentioned that the acute renal angina index (aRAI), a new concept, can be used in emergency departments to calculate and accurately predict the risk of developing acute kidney injury (AKI). The aims of the study included: to evaluate the predictive performance of the aRAI (AKI risk classification tool) in predicting AKI in the pediatric emergency department.

Method

Patients who met the criteria for systemic inflammatory response syndrome were examined. AKI was defined with creatinine N1.5× baseline 24–72 hours after hospitalization. aRAI and original RAI scores were calculated for patients and were shown as renal angina positive (RA+) above a population-derived threshold. The performance of aRAI in predicting AKI compared to changes in creatinine and original RAI was evaluated.

Results

In total, 241 eligible subjects were enrolled. The median age of the patients was 17 months (min–max 1–192). AKI developed in 60 (24.8%) of the patients. According to the aRAI, 76 (31.5%) of 241 patients were RA(+). The aRAI had an NPV of 1.00 and an AUC of 0.948 (0.914–0.983) for the prediction of AKI. Sensitivity was 95% for the aRAI as compared to 48% for an elevation in SCr noted to be at least two times greater than the baseline while in the PED and 61% for original RAI.

Conclusions

The aRAI is easily computable, does not depend on complex computational or derivation methods, and is universally accessible. We confirm and extend the findings of previous study reporting the performance of RAI for early prediction of AKI.

KEYWORDS:

• Emergency
• acute renal angina index
• acute kidney injury
• pediatric
• sepsis

Abbreviation

AKI, Acute kidney injury; PICU, pediatric intensive care unit; sCr, serum creatinine; RA, renal angina; RAI, renal angina index; PED, pediatric emergency department; aRAI, acute RAI

Disclosure statement

No potential conflict of interest was reported by the author(s).

Declaration of financial/other relationships

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Author contributions

MD Yaradılmış, MD Öztürk, Prof Tuygun and Karacan conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.

Drs Bodur, Güneylioğlu and Tekeli designed the data collection instruments, collected data, reviewed, and revised the manuscript.

Drs Yaradılmış, Göktuğ and Prof Karacan, carried out the initial analyses, reviewed and revised the manuscript.

All authors approve the final version of the manuscript and accept all the responsibilities.

Ethics approval

The protocol for this study was approved by the local ethics committee (E-20/12-48).

Availability of data

The data that support the findings of this study are available from the corresponding author upon reasonable request.