Evidence mapPaperPMID 41727778Full record

ArticleKidney international reports2026

Reference Change Value Based AKI Criteria in Critically Ill Children.

Harikrishnan Radhakrishnan, Sudarsan Krishnasamy, Bobbity Deepthi, Sivamurukan Palanisamy, Narayanan Parameswaran, Sriram Krishnamurthy

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Article in Kidney international reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Harikrishnan RadhakrishnanDepartment of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Sudarsan KrishnasamyPediatric Nephrology services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Bobbity DeepthiPediatric Nephrology services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Sivamurukan PalanisamyPediatric intensive care services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Narayanan ParameswaranPediatric intensive care services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Sriram KrishnamurthyPediatric Nephrology services, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Recently, a new criterion for acute kidney injury (AKI), the pediatric reference change value optimized for AKI in children (pROCK criterion), has been introduced, to account for the high analytical and biological variability observed with serum creatinine. However, there is limited information about this novel criterion. Methods: Consecutive children aged 1 month to 18 years admitted to the pediatric intensive care unit (PICU) of a tertiary care center from February 2023 to December 2024 were prospectively enrolled. Using the pROCK criterion, incidence of AKI within 7 days of PICU entry, and the diagnostic performance of this criteria was compared with other AKI criteria. Results: Of the 907 patients screened, 478 were found eligible and followed up with until discharge. The incidence of AKI as per pROCK, the Kidney Disease: Improving Global Outcomes (KDIGO), the Pediatric Risk, Injury, Failure, Loss of kidney function and End-stage renal disease (pRIFLE), and AKI Network (AKIN) criteria were 25.3%, 30.5%, 37.6%, and 30.5%, respectively. The incidence varied significantly based on the definition used to assume baseline creatinine, with the pROCK criteria identifying less false positives at low baseline creatinine. There was very good agreement between pROCK and KDIGO for identifying any AKI (kappa statistic [K] = 0.91) and No-AKI (K = 0.91), and good agreement for stage 3 AKI (K = 0.76). Whereas KDIGO offered the highest sensitivity (100%), pROCK had the highest specificity (96.2%). The pROCK criteria was an independent predictor of mortality. Conclusion: The pROCK criteria can effectively diagnose AKI, with the added advantage of specificity, thereby able to better identify "true AKI," especially in infants and young children with lower ranges of serum creatinine. Further refinement in the pROCK definition with incorporation of urine output criteria is warranted.

Indexed as

acute kidney injurycritically ill childrenKDIGO criteriapROCK criteria

Identifiers

PMID41727778
PMCPMC12917377

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