Assessment of a modified renal angina index for AKI prediction in critically ill adults

Victor Ortiz-Soriano, Shaowli Kabir, Rolando Claure-Del Granado, Arnold Stromberg, Robert D. Toto, Orson W. Moe, Stuart L. Goldstein, Javier A. Neyra

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


BACKGROUND: 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. METHODS: We used two independent intensive care unit (ICU) cohorts: 13 965 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 (ΔSCr) and fluid overload percentage within the first day of ICU admission. The primary outcome was AKI Stage ≥2 at Days 2-7. Performance and reclassification metrics were determined for the mRAI score compared with ΔSCr alone. RESULTS: The mRAI score outperformed ΔSCr and readjusted probabilities to predict AKI Stage ≥2 at Days 2-7: 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 < 0.001 for both). In the UKY cohort, only 3.3% of patients with mRAI score <10 had the AKI event, while 16.4% of patients with mRAI score of ≥10 had the AKI event (negative predictive value 96.8%). Similar findings were observed in the UTSW cohort as part of external validation. CONCLUSIONS: 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 ≥2 at Days 2-7 of ICU stay. The mRAI is a feasible tool for AKI risk stratification in adult patients in the ICU.

Original languageEnglish (US)
Pages (from-to)895-903
Number of pages9
JournalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Issue number5
StatePublished - Apr 25 2022


  • acute kidney injury
  • ICU
  • prediction
  • renal angina index
  • risk stratification

ASJC Scopus subject areas

  • Nephrology
  • Transplantation


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