{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:32:33Z","timestamp":1792794753854,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:00Z","timestamp":1613692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"University of Texas Southwestern Medical Center O\u2019Brien Kidney Research Core Center","award":["NIH, P30 DK079328-06"],"award-info":[{"award-number":["NIH, P30 DK079328-06"]}],"id":[{"id":"https:\/\/ror.org\/05byvp690","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100013844","name":"University of Kentucky Center for Clinical and Translational Science","doi-asserted-by":"publisher","award":["NIH\/NCATS, UL1TR001998"],"award-info":[{"award-number":["NIH\/NCATS, UL1TR001998"]}],"id":[{"id":"10.13039\/100013844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The renal angina index (RAI) is a useful tool for risk stratification of acute kidney injury (AKI) in critically ill children. We evaluated the performance of a modified adult RAI (mRAI) for the risk stratification of AKI in critically ill adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used two independent intensive care unit (ICU) cohorts: 13\u2009965 adult patients from the University of Kentucky (UKY) and 4789 from University of Texas Southwestern (UTSW). The mRAI included: diabetes, presence of sepsis, mechanical ventilation, pressor\/inotrope use, percentage change in serum creatinine (SCr) in reference to admission SCr (\u0394SCr) and fluid overload percentage within the first day of ICU admission. The primary outcome was AKI Stage \u22652 at Days 2\u20137. Performance and reclassification metrics were determined for the mRAI score compared with \u0394SCr alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mRAI score outperformed \u0394SCr and readjusted probabilities to predict AKI Stage \u22652 at Days 2\u20137: C-statistic: UKY 0.781 versus 0.708 [integrated discrimination improvement (IDI) 2.2%] and UTSW 0.766 versus 0.696 (IDI 1.8%) (P\u2009&amp;lt;\u20090.001 for both). In the UKY cohort, only 3.3% of patients with mRAI score &amp;lt;10 had the AKI event, while 16.4% of patients with mRAI score of \u226510 had the AKI event (negative predictive value 96.8%). Similar findings were observed in the UTSW cohort as part of external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In critically ill adults, the adult mRAI score determined within the first day of ICU admission outperformed changes in SCr for the prediction of AKI Stage \u22652 at Days 2\u20137 of ICU stay. The mRAI is a feasible tool for AKI risk stratification in adult patients in the ICU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfab049","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T03:28:18Z","timestamp":1613618898000},"page":"895-903","source":"Crossref","is-referenced-by-count":24,"title":["Assessment of a modified renal angina index for AKI prediction in critically ill adults"],"prefix":"10.1093","volume":"37","author":[{"given":"Victor","family":"Ortiz-Soriano","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center , Lexington, KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaowli","family":"Kabir","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Kentucky , Lexington, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8163-3779","authenticated-orcid":false,"given":"Rolando","family":"Claure-Del Granado","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Mayor San Simon , Cochabamba, Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold","family":"Stromberg","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Kentucky , Lexington, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D","family":"Toto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center , Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orson W","family":"Moe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center , Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart L","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Center for Acute Care Nephrology, Cincinnati Children\u2019s Hospital and Medical Center, University of Cincinnati , Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier A","family":"Neyra","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center , Lexington, KY, USA"},{"name":"Department of Internal Medicine, Division of Nephrology, Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center , Dallas, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"2022071110161159600_gfab049-B1","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.2215\/CJN.00710113","article-title":"World incidence of AKI: a meta-analysis","volume":"8","author":"Susantitaphong","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B2","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1681\/ASN.2009010041","article-title":"World Kidney Day 2009: problems and challenges in the emerging epidemic of kidney disease","volume":"20","author":"Szczech","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1038\/nrneph.2013.282","article-title":"Acute kidney injury\u2014epidemiology, outcomes and economics","volume":"10","author":"Rewa","year":"2014","journal-title":"Nat Rev Nephrol"},{"key":"2022071110161159600_gfab049-B4","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.2215\/CJN.04360514","article-title":"A prospective international multicenter study of AKI in the intensive care unit","volume":"10","author":"Bouchard","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B5","doi-asserted-by":"crossref","first-page":"70","DOI":"10.12788\/jhm.2683","article-title":"Cost of acute kidney injury in hospitalized patients","volume":"12","author":"Silver","year":"2017","journal-title":"J Hosp Med"},{"key":"2022071110161159600_gfab049-B6","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1681\/ASN.2014111114","article-title":"Elevated BP after AKI","volume":"27","author":"Hsu","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B7","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1681\/ASN.2013060610","article-title":"Long-term risk of coronary events after AKI","volume":"25","author":"Wu","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B8","doi-asserted-by":"crossref","first-page":"e000933","DOI":"10.1161\/JAHA.114.000933","article-title":"The impact of acute kidney injury on the long-term risk of stroke","volume":"3","author":"Wu","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2022071110161159600_gfab049-B9","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1681\/ASN.2016010105","article-title":"AKI and long-term risk for cardiovascular events and mortality","volume":"28","author":"Odutayo","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B10","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1186\/s13054-014-0492-2","article-title":"Three-year risk of cardiovascular disease among intensive care patients with acute kidney injury: a population-based cohort study","volume":"18","author":"Gammelager","year":"2014","journal-title":"Crit Care"},{"key":"2022071110161159600_gfab049-B11","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1038\/ki.2011.42","article-title":"The severity of acute kidney injury predicts progression to chronic kidney disease","volume":"79","author":"Chawla","year":"2011","journal-title":"Kidney Int"},{"key":"2022071110161159600_gfab049-B12","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.2215\/CJN.01120211","article-title":"Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus","volume":"6","author":"Thakar","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B13","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1053\/j.ajkd.2015.10.019","article-title":"Acute kidney injury recovery pattern and subsequent risk of CKD: an analysis of veterans health administration data","volume":"67","author":"Heung","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"2022071110161159600_gfab049-B14","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1038\/ki.2013.349","article-title":"Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children","volume":"85","author":"Basu","year":"2014","journal-title":"Kidney Int"},{"key":"2022071110161159600_gfab049-B15","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1001\/jama.2017.16326","article-title":"Derivation and external validation of prediction models for advanced chronic kidney disease following acute kidney injury","volume":"318","author":"James","year":"2017","journal-title":"JAMA"},{"key":"2022071110161159600_gfab049-B16","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1159\/000490119","article-title":"Risk prediction models for acute kidney injury in critically ill patients: opus in progressu","volume":"140","author":"Neyra","year":"2018","journal-title":"Nephron"},{"key":"2022071110161159600_gfab049-B17","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1097\/01.CCM.0000172279.66229.07","article-title":"External validation of severity scoring systems for acute renal failure using a multinational database","volume":"33","author":"Uchino","year":"2005","journal-title":"Crit Care Med"},{"key":"2022071110161159600_gfab049-B18","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1097\/01.ASN.0000014692.19351.52","article-title":"Refining predictive models in critically ill patients with acute renal failure","volume":"13","author":"Mehta","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"2022071110161159600_gfab049-B19","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1038\/ki.2012.266","article-title":"Mild elevation of urinary biomarkers in prerenal acute kidney injury","volume":"82","author":"Doi","year":"2012","journal-title":"Kidney Int"},{"key":"2022071110161159600_gfab049-B20","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1038\/ki.2012.23","article-title":"Some biomarkers of acute kidney injury are increased in pre-renal acute injury","volume":"81","author":"Nejat","year":"2012","journal-title":"Kidney Int"},{"key":"2022071110161159600_gfab049-B21","doi-asserted-by":"crossref","first-page":"R25","DOI":"10.1186\/cc12503","article-title":"Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury","volume":"17","author":"Kashani","year":"2013","journal-title":"Crit Care"},{"key":"2022071110161159600_gfab049-B22","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.ekir.2019.05.005","article-title":"Kidney tubular damage and functional biomarkers in acute kidney injury following cardiac surgery","volume":"4","author":"Neyra","year":"2019","journal-title":"Kidney Int Rep"},{"key":"2022071110161159600_gfab049-B23","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S2352-4642(17)30181-5","article-title":"Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study","volume":"2","author":"Basu","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"key":"2022071110161159600_gfab049-B24","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1542\/peds.107.6.1309","article-title":"Outcome in children receiving continuous venovenous hemofiltration","volume":"107","author":"Goldstein","year":"2001","journal-title":"Pediatrics"},{"key":"2022071110161159600_gfab049-B25","doi-asserted-by":"crossref","first-page":"461","DOI":"10.7326\/0003-4819-130-6-199903160-00002","article-title":"A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group","volume":"130","author":"Levey","year":"1999","journal-title":"Ann Intern Med"},{"key":"2022071110161159600_gfab049-B26","first-page":"1","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury","volume":"2","year":"2012","journal-title":"Kidney Int"},{"key":"2022071110161159600_gfab049-B27","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1097\/CCM.0b013e318228234b","article-title":"Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes","volume":"39","author":"Liu","year":"2011","journal-title":"Crit Care Med"},{"key":"2022071110161159600_gfab049-B28","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.kint.2019.05.026","article-title":"Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment","volume":"96","author":"Peerapornratana","year":"2019","journal-title":"Kidney Int"},{"key":"2022071110161159600_gfab049-B29","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1038\/ki.2009.159","article-title":"Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury","volume":"76","author":"Bouchard","year":"2009","journal-title":"Kidney Int"},{"key":"2022071110161159600_gfab049-B30","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1097\/CCM.0000000000001835","article-title":"Cumulative fluid balance and mortality in septic patients with or without acute kidney injury and chronic kidney disease","volume":"44","author":"Neyra","year":"2016","journal-title":"Crit Care Med"},{"key":"2022071110161159600_gfab049-B31","doi-asserted-by":"crossref","first-page":"e753","DOI":"10.1097\/CCM.0000000000003862","article-title":"Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy","volume":"47","author":"Woodward","year":"2019","journal-title":"Crit Care Med"},{"key":"2022071110161159600_gfab049-B32","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1002\/sim.1742","article-title":"Presentation of multivariate data for clinical use: the Framingham Study risk score functions","volume":"23","author":"Sullivan","year":"2004","journal-title":"Statist Med"},{"key":"2022071110161159600_gfab049-B33","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1002\/bimj.200710415","article-title":"Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection","volume":"50","author":"Ruopp","year":"2008","journal-title":"Biom J"},{"key":"2022071110161159600_gfab049-B34","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.ekir.2018.01.013","article-title":"Use of the renal angina index in determining acute kidney injury","volume":"3","author":"Matsuura","year":"2018","journal-title":"Kidney Int Rep"},{"key":"2022071110161159600_gfab049-B35","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1007\/s00134-017-4678-3","article-title":"AKIpredictor, an online prognostic calculator for acute kidney injury in adult critically ill patients: development, validation and comparison to serum neutrophil gelatinase-associated lipocalin","volume":"43","author":"Flechet","year":"2017","journal-title":"Intensive Care Med"},{"key":"2022071110161159600_gfab049-B36","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1007\/s00134-009-1711-1","article-title":"Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU population","volume":"36","author":"Cruz","year":"2010","journal-title":"Intensive Care Med"},{"key":"2022071110161159600_gfab049-B37","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1164\/rccm.200908-1214OC","article-title":"Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients","volume":"183","author":"de Geus","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"2022071110161159600_gfab049-B38","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1053\/j.ajkd.2009.07.020","article-title":"Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis","volume":"54","author":"Haase","year":"2009","journal-title":"Am J Kidney Dis"},{"key":"2022071110161159600_gfab049-B39","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1093\/ndt\/gfx026","article-title":"A risk prediction score for acute kidney injury in the intensive care unit","volume":"32","author":"Malhotra","year":"2017","journal-title":"Nephrol Dial Transplant"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfab049\/36738629\/gfab049.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/37\/5\/895\/44817888\/gfab049.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/37\/5\/895\/44817888\/gfab049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T06:16:59Z","timestamp":1657520219000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/37\/5\/895\/6144901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,19]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,2,19]]},"published-print":{"date-parts":[[2022,4,25]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfab049","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,5]]},"published":{"date-parts":[[2021,2,19]]}}}