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Evaluation of height-dependent and height-independent methods of estimating baseline serum creatinine in critically ill children

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Abstract

Background

Baseline serum creatinine (bSCr) is required for diagnosing acute kidney injury (AKI). In children, bSCr is commonly defined as the lowest measurement within 3 months of admission. Measured values are often missing and estimating bSCr using height-based glomerular filtration rate (GFR) equations is problematic when height is unavailable.

Methods

This is a retrospective cohort study including 538 children admitted to the intensive care unit (ICU) between 2003 and 2005 at two centers in Canada, with measured bSCr, height, and ICU-SCr values. We evaluated the bias, accuracy, and precision of back-calculating bSCr from height-dependent and height-independent GFR equations. Agreement of AKI defined using measured and estimated bSCr was calculated. Multivariate analyses were performed to assess the impact of bSCr estimation methods on the association between AKI and ICU mortality, length of stay, and duration of mechanical ventilation.

Results

Both methods underestimated bSCr by 1–3%, showed good accuracy (∼30% of patients with estimated bSCr within 10% of measured bSCr), but poor precision (wide 95% limits of agreement). The agreement between AKI defined by estimated versus measured bSCr was >80% (κ >0.5). The height-independent method performed best in children >13 years old; however, overall, both methods performed similarly across age subgroups. AKI was associated with longer stay, prolonged mechanical ventilation, and ICU mortality using measured and estimated bSCr.

Conclusions

Height-dependent and height-independent bSCr estimation methods were comparable. This may have significant implications for performing pediatric AKI research using large databases, and in clinical care to define AKI when height is unknown.

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Acknowledgements

We acknowledge the research assistants at Centre Hospitalier Universitaire Sainte-Justine, Mariana Dumitrascu, Kahina Bensaadi, and Aldric Desavelle, who performed the data collection and G.M. who performed the validation of the database. We also acknowledge the research assistants at the Montreal Children’s Hospital, Shari Segal, R.A., N.R. who performed data collection, and Jillian Caldwell and M.P. who performed the validation of the database. M.Z. received research support from Fonds de Recherche en Santé du Québec, which allowed him to perform this work.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, Montreal Children’s Hospital, McGill University Health Centre, 1001 Blvd Decarie, Room BRC.6168, Montreal, QC, H4A 3J1, Canada

    Erin Hessey, Michael Pizzi & Michael Zappitelli

  2. Department of Family Medicine, GMF Centre Medical Hochelaga, Montreal, QC, Canada

    Rami Ali

  3. Department of Family-Emergency Medicine, Hôpital Général de Hawkesbury and District General Hospital Inc, Hawkesbury, ON, Canada

    Rami Ali

  4. StatScience Inc, Notre-Dame-de-l’Île-Perrot, QC, Canada

    Marc Dorais

  5. Department of Pediatrics, Pediatric Intensive Care unit, Centre mère-enfant Soleil, Centre Hospitalier de l’Université Laval, Quebec, QC, Canada

    Geneviève Morissette

  6. Department of Pediatrics, Pediatric Intensive Care Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada

    Philippe Jouvet & Jacques Lacroix

  7. Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Nikki Rink

  8. Department of Pediatrics, Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada

    Véronique Phan

Authors
  1. Erin Hessey
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  2. Rami Ali
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  3. Marc Dorais
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  4. Geneviève Morissette
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  5. Michael Pizzi
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  6. Nikki Rink
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  7. Philippe Jouvet
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  8. Jacques Lacroix
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  9. Véronique Phan
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  10. Michael Zappitelli
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Corresponding author

Correspondence to Michael Zappitelli.

Ethics declarations

Ethics board approval was obtained at both centers. Requirement for patient consent was waived.

Funding

All phases of this study were supported by Fond de recherche du Québec—Santé (FRQS; grant number 22888 [to P.J., J.L., V.P., M.Z.]). M.Z. was also supported by a research salary award and E.H. by a graduate studies award from the FRQS. The authors have no financial conflicts of interest relevant to this article to disclose.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Hessey, E., Ali, R., Dorais, M. et al. Evaluation of height-dependent and height-independent methods of estimating baseline serum creatinine in critically ill children. Pediatr Nephrol 32, 1953–1962 (2017). https://doi.org/10.1007/s00467-017-3670-z

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  • DOI: https://doi.org/10.1007/s00467-017-3670-z

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