Methods to estimate baseline creatinine and define acute kidney injury in lean Ugandan children with severe malaria: a prospective cohort study.
Methods to estimate baseline creatinine and define acute kidney injury in lean Ugandan children with severe malaria: a prospective cohort study.
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DOI：
10.1186/s12882-020-02076-1
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发表时间：
2020-09-29
期刊：
影响因子：
2.3
通讯作者：
Conroy AL
中科院分区：
文献类型：
--
作者：
Batte A;Starr MC;Schwaderer AL;Opoka RO;Namazzi R;Phelps Nishiguchi ES;Ssenkusu JM;John CC;Conroy AL
急性肾损伤(AKI)越来越被认为是严重疟疾儿童的一种相应的临床并发症。然而，在这一独特的患者群体中，估计基线肌酐(BScr)的方法并不标准化。在广泛使用之前，需要在许多人群中评估bscr估计方法，特别是在低收入国家的儿童中。我们在两组患有严重疟疾的儿童(n 1078)和健康社区儿童(n 289)中评估了6种方法来估计6 = 月至12 = 岁的乌干达儿童的bSCr。使用来自社区儿童的同位素稀释质谱仪(IDMS)可追踪的肌酐测量，我们评估了使用身高相关和身高无关的估计肾小球滤过(EGFR)方程来反向计算bScr或直接使用已发表的或特定于人群的标准来估计bScr的偏倚、准确性和精确度。我们比较了在健康社区儿童中估计bSCR的方法与IDMS可追踪的SCR测量方法。与施瓦茨身高方程相比，假设正常的肾小球滤过率为每1.73平方米120Schwartz毫升/分钟，基于波特尔年龄的方程是更准确、偏差最小的方法。使用不同的bSCr估计，我们证明KDIGO定义的AKI在患有严重疟疾的儿童中的患病率在15.6-43.4%之间。最低估计值是使用正常人群的上限，最高估计值是使用社区儿童的平均肾小球滤过率(137GFR/ 毫升/分钟/1.73m~2)来反算bSCr。无论采用何种治疗方法，急性心肌梗死与死亡率密切相关，急性心肌梗死各期死亡率均呈逐步上升趋势(p <； 0.0001)。根据Pottel年龄方程定义的AKI与死亡率的相关性最强，校正了儿童年龄和性别的风险比为5.13(95%可信区间3.03~8.68)。我们建议使用与身高无关的、基于年龄的方法来估计撒哈拉以南非洲住院儿童的bScr，因为精确的身高测量和营养不良可能会影响bScr的估计。在这一人群中，基于Pottel年龄的GFR估计方程获得了与健康儿童基于人群的估计值相当的bSCr估计。
Acute kidney injury (AKI) is increasingly recognized as a consequential clinical complication in children with severe malaria. However, approaches to estimate baseline creatinine (bSCr) are not standardized in this unique patient population. Prior to wide-spread utilization, bSCr estimation methods need to be evaluated in many populations, particularly in children from low-income countries. We evaluated six methods to estimate bSCr in Ugandan children aged 6 months to 12 years of age in two cohorts of children with severe malaria (n = 1078) and healthy community children (n = 289). Using isotope dilution mass spectrometry (IDMS)-traceable creatinine measures from community children, we evaluated the bias, accuracy and precision of estimating bSCr using height-dependent and height-independent estimated glomerular filtration (eGFR) equations to back-calculate bSCr or estimating bSCr directly using published or population-specific norms. We compared methods to estimate bSCr in healthy community children against the IDMS-traceable SCr measure. The Pottel-age based equation, assuming a normal GFR of 120 mL/min per 1.73m2, was the more accurate method with minimal bias when compared to the Schwartz height-based equation. Using the different bSCr estimates, we demonstrated the prevalence of KDIGO-defined AKI in children with severe malaria ranged from 15.6–43.4%. The lowest estimate was derived using population upper levels of normal and the highest estimate was derived using the mean GFR of the community children (137 mL/min per 1.73m2) to back-calculate the bSCr. Irrespective of approach, AKI was strongly associated with mortality with a step-wise increase in mortality across AKI stages (p < 0.0001 for all). AKI defined using the Pottel-age based equation to estimate bSCr showed the strongest relationship with mortality with a risk ratio of 5.13 (95% CI 3.03–8.68) adjusting for child age and sex. We recommend using height-independent age-based approaches to estimate bSCr in hospitalized children in sub-Saharan Africa due to challenges in accurate height measurements and undernutrition which may impact bSCr estimates. In this population the Pottel-age based GFR estimating equation obtained comparable bSCr estimates to population-based estimates in healthy children.
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DOI：
10.1053/j.ajkd.2012.03.014
发表时间：
2012-09
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Jones J;Holmen J;De Graauw J;Jovanovich A;Thornton S;Chonchol M
通讯作者：
Chonchol M
DOI：
10.1056/nejmoa1611391
发表时间：
2017-01-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Kaddourah A;Basu RK;Bagshaw SM;Goldstein SL;AWARE Investigators
通讯作者：
AWARE Investigators
急性肾脏损伤的步枪标准与重症患者的医院死亡率有关：一项队列分析。
影响因子：
15.1
作者：
Hoste, Eric A. J.;Clermont, Gilles;Kersten, Alexander;Venkataraman, Ramesh;Angus, Derek C.;De Bacquer, Dirk;Kellum, John A.
通讯作者：
Kellum, John A.
影响因子：
2.3
作者：
Basu, Rajit K.;Kaddourah, Ahmad;Goldstein, Stuart L.
通讯作者：
Goldstein, Stuart L.
影响因子：
11.8
作者：
Bangirana, Paul;Opoka, Robert O.;John, Chandy C.
通讯作者：
John, Chandy C.