A Longitudinal Renal Health Outcome for Clinical Trials in Acute Kidney Injury?

JohnProwle: > For AKI creatinine changes are fold changes x1.5, x2 or x3 (not subtractive) within a seven day period and indicate the slope of rise, and thus the eventual plateau in creatinine reflecting the actual underlying kidney function outside of steady state. We would also discount any SCr does not work for either subtraction or for fold-change. I’ve learned a lot from our analysis of critically ill patients in the SUPPORT study where we have data on days 1, 3, 7, 14, 25 but unfortunately I forgot to include dialysis status in creating the easier-to-use public datasets in Datasets. Some of what I learned is in 14  Transformations, Measuring Change, and Regression to the Mean – Biostatistics for Biomedical Research . SCr is more prognostic than eGFR and does not require sex or age interactions as eGFR does (I know the opposite is supposed to be true). You can look at patterns of SCr over time to predict ultimate outcome - either death or a later SCr. The prognostic value comes mostly from the last measured SCr and it has a very nonlinear, indeed nonmonotonic effect (but the latter could be caused by rescue dialysis). I think we need more intensive analysis of serially collected physiologic measures to derive a sensitive and prognostic function measure.