Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study

Abstract Background Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum c...

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Autores principales:	Anthony Batte, Kristin J. Murphy, Ruth Namazzi, Katrina Co, Robert O. Opoka, John M. Ssenkusu, Chandy C. John, Andrea L. Conroy
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Acute kidney injury Diagnosis Point-of-care testing Sub-Saharan Africa Prevalence Mortality Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/a78f960e701545c5801f89ee5504c0b8
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spelling	oai:doaj.org-article:a78f960e701545c5801f89ee5504c0b82021-11-08T11:18:06ZEvaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study10.1186/s12882-021-02573-x1471-2369https://doaj.org/article/a78f960e701545c5801f89ee5504c0b82021-11-01T00:00:00Zhttps://doi.org/10.1186/s12882-021-02573-xhttps://doaj.org/toc/1471-2369Abstract Background Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria. Methods Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria. Results The mean age of children was 2.1 years, and 21.6% of children were stunted. Mortality was 7.6% in-hospital. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R2 values of 0.95 and 0.93 respectively; however, the correlation was significantly lower in children with creatinine values <1mg/dL (R2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality (p<0.0001 for all). AKI defined using the reference creatinine measure was the most sensitive to predict mortality with a sensitivity of 85.4% compared to 70.7 and 63.4% with the adjusted and unadjusted point-of-care creatinine values, respectively. Conclusions Point-of-care assessment of creatinine in lean Ugandan children <4 years of age underestimated creatinine and AKI compared to the clinical reference. Additional studies are needed to evaluate other biomarkers of AKI in LMIC to ensure equitable access to AKI diagnostics globally.Anthony BatteKristin J. MurphyRuth NamazziKatrina CoRobert O. OpokaJohn M. SsenkusuChandy C. JohnAndrea L. ConroyBMCarticleAcute kidney injuryDiagnosisPoint-of-care testingSub-Saharan AfricaPrevalenceMortalityDiseases of the genitourinary system. UrologyRC870-923ENBMC Nephrology, Vol 22, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Acute kidney injury Diagnosis Point-of-care testing Sub-Saharan Africa Prevalence Mortality Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Acute kidney injury Diagnosis Point-of-care testing Sub-Saharan Africa Prevalence Mortality Diseases of the genitourinary system. Urology RC870-923 Anthony Batte Kristin J. Murphy Ruth Namazzi Katrina Co Robert O. Opoka John M. Ssenkusu Chandy C. John Andrea L. Conroy Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study
description	Abstract Background Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria. Methods Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria. Results The mean age of children was 2.1 years, and 21.6% of children were stunted. Mortality was 7.6% in-hospital. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R2 values of 0.95 and 0.93 respectively; however, the correlation was significantly lower in children with creatinine values <1mg/dL (R2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality (p<0.0001 for all). AKI defined using the reference creatinine measure was the most sensitive to predict mortality with a sensitivity of 85.4% compared to 70.7 and 63.4% with the adjusted and unadjusted point-of-care creatinine values, respectively. Conclusions Point-of-care assessment of creatinine in lean Ugandan children <4 years of age underestimated creatinine and AKI compared to the clinical reference. Additional studies are needed to evaluate other biomarkers of AKI in LMIC to ensure equitable access to AKI diagnostics globally.
format	article
author	Anthony Batte Kristin J. Murphy Ruth Namazzi Katrina Co Robert O. Opoka John M. Ssenkusu Chandy C. John Andrea L. Conroy
author_facet	Anthony Batte Kristin J. Murphy Ruth Namazzi Katrina Co Robert O. Opoka John M. Ssenkusu Chandy C. John Andrea L. Conroy
author_sort	Anthony Batte
title	Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study
title_short	Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study
title_full	Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study
title_fullStr	Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study
title_full_unstemmed	Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study
title_sort	evaluating kidney function using a point-of-care creatinine test in ugandan children with severe malaria: a prospective cohort study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a78f960e701545c5801f89ee5504c0b8
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Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study

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