Browsing by Author "Basu, Rajit K."
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Item Acute Kidney Injury and Fluid Overload in Pediatric Cardiac Surgery(Springer, 2019-12) Carlisle, Michael A.; Soranno, Danielle E.; Basu, Rajit K.; Gist, Katja M.; Pediatrics, School of MedicinePurpose of review: Acute kidney injury (AKI) and fluid overload affect a large number of children undergoing cardiac surgery, and confers an increased risk for adverse complications and outcomes including death. Survivors of AKI suffer long-term sequelae. The purpose of this narrative review is to discuss the short and long-term impact of cardiac surgery associated AKI and fluid overload, currently available tools for diagnosis and risk stratification, existing management strategies, and future management considerations. Recent findings: Improved risk stratification, diagnostic prediction tools and clinically available early markers of tubular injury have the ability to improve AKI-associated outcomes. One of the major challenges in diagnosing AKI is the diagnostic imprecision in serum creatinine, which is impacted by a variety of factors unrelated to renal disease. In addition, many of the pharmacologic interventions for either AKI prevention or treatment have failed to show any benefit, while peritoneal dialysis catheters, either for passive drainage or prophylactic dialysis may be able to mitigate the detrimental effects of fluid overload. Summary: Until novel risk stratification and diagnostics tools are integrated into routine practice, supportive care will continue to be the mainstay of therapy for those affected by AKI and fluid overload after pediatric cardiac surgery. A viable series of preventative measures can be taken to mitigate the risk and severity of AKI and fluid overload following cardiac surgery, and improve care.Item Acute kidney injury in critically Ill children and young adults with suspected SARS-CoV2 infection(Springer Nature, 2022-06) Basu, Rajit K.; Bjornstad, Erica C.; Gist, Katja M.; Starr, Michelle; Khandhar, Paras; Chanchlani, Rahul; Krallman, Kelli A.; Zappitelli, Michael; Askenazi, David; Goldstein, Stuart L.; Pediatrics, School of MedicineBackground: We aimed to study the association of suspected versus confirmed infection with the novel SARS-CoV2 virus with the prevalence of acute kidney injury (AKI) in critically ill children. Methods: Sequential point-prevalence study of children and young adults aged 7 days to 25 years admitted to intensive care units under investigation for SARS-CoV2 infection. AKI was staged in the first 14 days of enrollment using KDIGO creatinine-based staging. SARS-CoV2 positive (CONFIRMED) were compared to SUSPECTED (negative or unknown). Outcome data was censored at 28-days. Results: In 331 patients of both sexes, 179 (54.1%) were CONFIRMED, 4.2% (14) died. AKI occurred in 124 (37.5%) and severe AKI occurred in 63 (19.0%). Incidence of AKI in CONFIRMED was 74/179 (41.3%) versus 50/152 (32.9%) for SUSPECTED; severe AKI occurred in 35 (19.6%) of CONFIRMED and 28 (18.4%) of SUSPECTED. Mortality was 6.2% (n = 11) in CONFIRMED, but 9.5% (n = 7) in those CONFIRMED with AKI. On multivariable analysis, only Hispanic ethnicity (relative risk 0.5, 95% CI 0.3-0.9) was associated with less AKI development among those CONFIRMED. Conclusions: AKI and severe AKI occur commonly in critically ill children with SARS-CoV2 infection, more than double the historical standard. Further investigation is needed during this continuing pandemic to describe and refine the understanding of pediatric AKI epidemiology and outcomes. Trial registration: NCT01987921. Impact: What is the key message of the article? AKI occurs in children exposed to the novel SARS-CoV2 virus at high prevalence (~40% with some form of AKI and 20% with severe AKI). What does it add to the existing literature? Acute kidney injury (AKI) occurs commonly in adult patients with SARS-CoV2 (COVID), very little data describes the epidemiology of AKI in children exposed to the virus. What is the impact? A pediatric vaccine is not available; thus, the pandemic is not over for children. Pediatricians will need to manage significant end-organ ramifications of the novel SARS-CoV2 virus including AKI.Item Consensus-Based Recommendations on Priority Activities to Address Acute Kidney Injury in Children: A Modified Delphi Consensus Statement(American Medical Association, 2022-09-01) Goldstein, Stuart L.; Akcan-Arikan, Ayse; Alobaidi, Rashid; Askenazi, David J.; Bagshaw, Sean M.; Barhight, Matthew; Barreto, Erin; Bayrakci, Benan; Bignall, Orville N. R.; Bjornstad, Erica; Brophy, Patrick D.; Chanchlani, Rahul; Charlton, Jennifer R.; Conroy, Andrea L.; Deep, Akash; Devarajan, Prasad; Dolan, Kristin; Fuhrman, Dana Y.; Gist, Katja M.; Gorga, Stephen M.; Greenberg, Jason H.; Hasson, Denise; Heydari Ulrich, Emma; Iyengar, Arpana; Jetton, Jennifer G.; Krawczeski, Catherine; Meigs, Leslie; Menon, Shina; Morgan, Jolyn; Morgan, Catherine J.; Mottes, Theresa; Neumayr, Tara M.; Ricci, Zaccaria; Selewski, David; Soranno, Danielle E.; Starr, Michelle; Stanski, Natalja L.; Sutherland, Scott M.; Symons, Jordan; Tavares, Marcelo S.; Wong Vega, Molly; Zappitelli, Michael; Ronco, Claudio; Mehta, Ravindra L.; Kellum, John; Ostermann, Marlies; Basu, Rajit K.; Pediatric ADQI Collaborative; Pediatrics, School of MedicineImportance: Increasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge. Objective: To develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy. Evidence review: At the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations. Findings: The meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy. Conclusions and relevance: Existing evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts.Item External validation of the modified sepsis renal angina index for prediction of severe acute kidney injury in children with septic shock(Springer Nature, 2023-11-28) Stanski, Natalja L.; Basu, Rajit K.; Cvijanovich, Natalie Z.; Fitzgerald, Julie C.; Bigham, Michael T.; Jain, Parag N.; Schwarz, Adam J.; Lutfi, Riad; Thomas, Neal J.; Baines, Torrey; Haileselassie, Bereketeab; Weiss, Scott L.; Atreya, Mihir R.; Lautz, Andrew J.; Zingarelli, Basilia; Standage, Stephen W.; Kaplan, Jennifer; Chawla, Lakhmir S.; Goldstein, Stuart L.; Pediatrics, School of MedicineBackground: Acute kidney injury (AKI) occurs commonly in pediatric septic shock and increases morbidity and mortality. Early identification of high-risk patients can facilitate targeted intervention to improve outcomes. We previously modified the renal angina index (RAI), a validated AKI prediction tool, to improve specificity in this population (sRAI). Here, we prospectively assess sRAI performance in a separate cohort. Methods: A secondary analysis of a prospective, multicenter, observational study of children with septic shock admitted to the pediatric intensive care unit from 1/2019 to 12/2022. The primary outcome was severe AKI (≥ KDIGO Stage 2) on Day 3 (D3 severe AKI), and we compared predictive performance of the sRAI (calculated on Day 1) to the original RAI and serum creatinine elevation above baseline (D1 SCr > Baseline +). Original renal angina fulfillment (RAI +) was defined as RAI ≥ 8; sepsis renal angina fulfillment (sRAI +) was defined as RAI ≥ 20 or RAI 8 to < 20 with platelets < 150 × 103/µL. Results: Among 363 patients, 79 (22%) developed D3 severe AKI. One hundred forty (39%) were sRAI + , 195 (54%) RAI + , and 253 (70%) D1 SCr > Baseline + . Compared to sRAI-, sRAI + had higher risk of D3 severe AKI (RR 8.9, 95%CI 5-16, p < 0.001), kidney replacement therapy (KRT) (RR 18, 95%CI 6.6-49, p < 0.001), and mortality (RR 2.5, 95%CI 1.2-5.5, p = 0.013). sRAI predicted D3 severe AKI with an AUROC of 0.86 (95%CI 0.82-0.90), with greater specificity (74%) than D1 SCr > Baseline (36%) and RAI + (58%). On multivariable regression, sRAI + retained associations with D3 severe AKI (aOR 4.5, 95%CI 2.0-10.2, p < 0.001) and need for KRT (aOR 5.6, 95%CI 1.5-21.5, p = 0.01). Conclusions: Prediction of severe AKI in pediatric septic shock is important to improve outcomes, allocate resources, and inform enrollment in clinical trials examining potential disease-modifying therapies. The sRAI affords more accurate and specific prediction than context-free SCr elevation or the original RAI in this population.Item Pediatric AKI in the real world: changing outcomes through education and advocacy-a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference(Springer, 2024) Mottes, Theresa; Menon, Shina; Conroy, Andrea; Jetton, Jennifer; Dolan, Kristin; Arikan, Ayse Akcan; Basu, Rajit K.; Goldstein, Stuart L.; Symons, Jordan M.; Alobaid, Rashid; Askenazi, David J.; Bagshaw, Sean M.; Barhight, Matthew; Barreto, Erin; Bayrakci, Benan; Bignall, O. N., II; Bjornstad, Erica; Brophy, Patrick; Charlton, Jennifer; Chanchlani, Rahul; Conroy, Andrea L.; Deep, Akash; Devarajan, Prasad; Fuhrman, Dana; Gist, Katja M.; Gorga, Stephen M.; Greenberg, Jason H.; Hasson, Denise; Heydari, Emma; Iyengar, Arpana; Krawczeski, Catherine; Meigs, Leslie; Morgan, Catherine; Morgan, Jolyn; Neumayr, Tara; Ricci, Zaccaria; Selewski, David T.; Soranno, Danielle; Stanski, Natalja; Starr, Michelle; Sutherland, Scott M.; Symons, Jordan; Tavares, Marcelo; Vega, Molly; Zappitelli, Michael; Ronco, Claudio; Mehta, Ravindra L.; Kellum, John; Ostermann, Marlies; ADQI 26 workgroup; Pediatrics, School of MedicineBackground: Acute kidney injury (AKI) is independently associated with increased morbidity and mortality across the life course, yet care for AKI remains mostly supportive. Raising awareness of this life-threatening clinical syndrome through education and advocacy efforts is the key to improving patient outcomes. Here, we describe the unique roles education and advocacy play in the care of children with AKI, discuss the importance of customizing educational outreach efforts to individual groups and contexts, and highlight the opportunities created through innovations and partnerships to optimize lifelong health outcomes. Methods: During the 26th Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations on AKI research, education, practice, and advocacy in children. Results: The consensus statements developed in response to three critical questions about the role of education and advocacy in pediatric AKI care are presented here along with a summary of available evidence and recommendations for both clinical care and research. Conclusions: These consensus statements emphasize that high-quality care for patients with AKI begins in the community with education and awareness campaigns to identify those at risk for AKI. Education is the key across all healthcare and non-healthcare settings to enhance early diagnosis and develop mitigation strategies, thereby improving outcomes for children with AKI. Strong advocacy efforts are essential for implementing these programs and building critical collaborations across all stakeholders and settings.Item Transient and persistent acute kidney injury phenotypes following the Norwood operation: a retrospective study(Cambridge University Press, 2022) Gist, Katja M.; Borasino, Santiago; SooHoo, Megan; Soranno, Danielle E.; Mack, Emily; Hock, Kristal M.; Rahman, A. K. M. Fazlur; Brinton, John T.; Basu, Rajit K.; Alten, Jeffrey A.; Pediatrics, School of MedicineBackground: Acute kidney injury is a common complication following the Norwood operation. Most neonatal studies report acute kidney injury peaking within the first 48 hours after cardiac surgery. The aim of this study was to evaluate if persistent acute kidney injury (>48 postoperative hours) after the Norwood operation was associated with clinically relevant outcomes. Methods: Two-centre retrospective study among neonates undergoing the Norwood operation. Acute kidney injury was initially identified as developing within the first 48 hours after cardiac surgery and stratified into transient (≤48 hours) and persistent (>48 hours) using the neonatal modification of the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Severe was defined as stage ≥2. Primary and secondary outcomes were mortality and duration of ventilation and hospital length of stay. Results: One hundred sixty-eight patients were included. Transient and persistent acute kidney injuries occurred in 24 and 17%, respectively. Cardiopulmonary bypass and aortic cross clamp duration, and incidence of cardiac arrest were greater among those with persistent kidney injury. Mortality was four times higher (41 versus 12%, p < 0.001) and mechanical ventilation duration 50 hours longer in persistent acute kidney injury patients (158 versus 107 hours; p < 0.001). In multivariable analysis, persistent acute kidney injury was not associated with mortality, duration of ventilation or length of stay. Severe persistent acute kidney injury was associated with a 59% increase in expected ventilation duration (aIRR:1.59, 95% CI:1.16, 2.18; p = 0.004). Conclusions: Future large studies are needed to determine if risk factors and outcomes change by delineating acute kidney injury into discrete timing phenotypes.