Abstract: FR-PO049
Saliva Urea Nitrogen Improves Mortality Prediction in Children with Malnutrition and AKI
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention - 2
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Batte, Anthony, Makerere University College of Health Sciences, Kampala, Kampala, Uganda
- Bassat, Quique, Fundacion Privada Instituto de Salud Global Barcelona, Barcelona, Catalunya, Spain
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Raimann, Jochen G., Renal Research Institute, New York, New York, United States
- Conroy, Andrea L., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
Acute malnutrition is a leading cause of pediatric mortality and a risk for acute kidney injury (AKI). We evaluated the utility of saliva urea nitrogen (SUN) test strips and AKI to predict mortality in children hospitalized with acute malnutrition.
Methods
This study prospectively enrolled 185 children 6 months to 10 years of age hospitalized with acute malnutrition at Mulago National Referral hospital, Uganda from September 2020 to February 2021. Creatinine was measured using the modified Jaffe method that is IDMS-traceable. AKI was defined using a modified Kidney Disease: Improving Global Outcomes AKI definition (mKDIGO) using serial creatinine measures over hospitalization. Of 574 creatinine measures, 193 (33.6%) were below the assay limit of detection and assigned a value of 0.16mg/dL. Children required a maximum creatinine value ≥0.4mg/dL to be classified as having AKI. SUN was measured at bedside using semi-quantitative point of care strips. Enrolled children had weight-for-age or heigh-for-age z-scores <-2 SD. We used the modified Poisson regression and receiver operating curve (ROC) analysis.
Results
A total of 185 children were enrolled (36.2% female) and 25 children died (13.5%). Overall, 43 children (23.2%) met the definition for mKDIGO AKI and a positive SUN test (SUN ≥11mg/dL) was found in 105 children (56.8%). A positive SUN test was associated with a risk ratio (RR) of AKI of 2.88 (95% CI 1.46, 5.66) and severe AKI (AKI stage 2 & 3) RR 4.1 (95% CI 1.7 to 10.2). mKDIGO AKI (RR 3.58 95% CI 1.76 to 7.27) and a positive SUN test (RR 8.76 95% CI 2.12 to 36.22) were associated with mortality. The area under the ROC for AKI and a positive SUN test to predict mortality were 0.67 (95% CI 0.56 to 0.77) and 0.76 (95% CI 0.64 to 0.77), respectively. Incorporating both SUN and AKI significantly improved mortality prediction compared to either marker alone with an area under the ROC of 0.77 (95% CI 0.69 to 0.84).
Conclusion
SUN is a non-invasive tool that is associated with acute kidney injury and mortality in children with acute malnutrition. This point of care tool may provide additional benefit in risk stratification and prognostication of hospitalized children at risk of death when used in combination with creatinine based AKI definitions.
Funding
- Other NIH Support