---
title: "Renal Angina Index predicts severe AKI in Vietnamese PICU: prospective validation"
id: "pubmed-42909503"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42909503"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42909503/"
doi: "10.1007/s00467-026-07563-5"
published_at: "2026-10-23T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Renal Angina Index predicts severe AKI in Vietnamese PICU: prospective validation
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42909503
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42909503/)
- **DOI:** [10.1007/s00467-026-07563-5](https://doi.org/10.1007%2Fs00467-026-07563-5)
- **Published At:** 2026-10-23T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Prospective observational cohort at Vietnam National Children’s Hospital PICU, October 2024–June 2025, enrolling children aged 1 month to <18 years when the **Renal Angina Index** (RAI) could be calculated within 24 hours of admission. - Primary outcome: severe **acute kidney injury** (AKI) at 72 hours, defined as KDIGO stage 2–3; secondary outcomes included incident AKI, kidney replacement therapy, and PICU mortality. - Sample size: 314 children; severe AKI occurred in 56 patients (17.8%). - Discrimination: RAI AUC 0.790 (95% CI 0.741–0.834) for severe AKI; at RAI ≥8 cutoff sensitivity 78.6% and specificity 70.5%. - For incident AKI, RAI AUC reported as 0.752 (95% CI 0.643–0.861). - Multivariable analysis: RAI ≥8 independently associated with severe AKI (adjusted OR 7.40; 95% CI 2.51–21.78; p < 0.001). - RAI outperformed serum creatinine changes and fluid overload in predicting severe AKI in this cohort. - Ethics and governance: Institutional Review Board approval (Approval No. 2424/BVNTW-HĐĐĐ; Sept 23, 2024); parental informed consent obtained. - Authors reported the study as applicable to resource-limited PICU settings; the source did not report granular RAI component thresholds, individual baseline creatinine definitions, or timing/criteria for kidney replacement therapy initiation beyond listed endpoints.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # External validation of the renal angina index for early prediction of severe acute kidney injury in critically ill children: a prospective cohort study from Vietnam [Anh Tuan Ta](https://pubmed.ncbi.nlm.nih.gov/?term=Ta+AT&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-2 "Hanoi Medical University, Hanoi, Vietnam."), [Kiem Thang Do](https://pubmed.ncbi.nlm.nih.gov/?term=Do+KT&cauthor_id=42909503)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-2 "Hanoi Medical University, Hanoi, Vietnam."), [Ngoc Canh Hoang](https://pubmed.ncbi.nlm.nih.gov/?term=Hoang+NC&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam."), [Viet Hung Dau](https://pubmed.ncbi.nlm.nih.gov/?term=Dau+VH&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam."), [Tien Dong Ngo](https://pubmed.ncbi.nlm.nih.gov/?term=Ngo+TD&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam."), [Kim Lam Hoang](https://pubmed.ncbi.nlm.nih.gov/?term=Hoang+KL&cauthor_id=42909503)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-3 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#full-view-affiliation-4 "Hanoi Medical University, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn.") Affiliations Expand ### Affiliations * 1 Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam. * 2 Hanoi Medical University, Hanoi, Vietnam. * 3 Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn. * 4 Hanoi Medical University, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn. * PMID: **42909503** * DOI: [ 10.1007/s00467-026-07563-5 ](https://doi.org/10.1007/s00467-026-07563-5) Item in Clipboard # External validation of the renal angina index for early prediction of severe acute kidney injury in critically ill children: a prospective cohort study from Vietnam Anh Tuan Ta et al. Pediatr Nephrol. 2026. Show details Display options Display options Format Abstract PubMed PMID Pediatr Nephrol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Pediatr+Nephrol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Pediatr+Nephrol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42909503/) . 2026 Oct 23. doi: 10.1007/s00467-026-07563-5. Online ahead of print. ### Authors [Anh Tuan Ta](https://pubmed.ncbi.nlm.nih.gov/?term=Ta+AT&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-2 "Hanoi Medical University, Hanoi, Vietnam."), [Kiem Thang Do](https://pubmed.ncbi.nlm.nih.gov/?term=Do+KT&cauthor_id=42909503)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-2 "Hanoi Medical University, Hanoi, Vietnam."), [Ngoc Canh Hoang](https://pubmed.ncbi.nlm.nih.gov/?term=Hoang+NC&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam."), [Viet Hung Dau](https://pubmed.ncbi.nlm.nih.gov/?term=Dau+VH&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam."), [Tien Dong Ngo](https://pubmed.ncbi.nlm.nih.gov/?term=Ngo+TD&cauthor_id=42909503)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam."), [Kim Lam Hoang](https://pubmed.ncbi.nlm.nih.gov/?term=Hoang+KL&cauthor_id=42909503)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-3 "Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42909503/#short-view-affiliation-4 "Hanoi Medical University, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn.") ### Affiliations * 1 Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam. * 2 Hanoi Medical University, Hanoi, Vietnam. * 3 Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn. * 4 Hanoi Medical University, Hanoi, Vietnam. hoangkimlam@hmu.edu.vn. * PMID: **42909503** * DOI: [ 10.1007/s00467-026-07563-5 ](https://doi.org/10.1007/s00467-026-07563-5) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Acute kidney injury (AKI) is common in critically ill children and is associated with poor outcomes. The Renal Angina Index (RAI) has been proposed as an early risk stratification tool, but evidence from low- and middle-income countries remains limited. **Methods:** We conducted a prospective observational cohort study in the pediatric intensive care unit of Vietnam National Children's Hospital from October 2024 to June 2025. Children aged 1 month to under 18 years were included if RAI could be calculated within 24 h of admission. The primary outcome was severe AKI at 72 h, defined as KDIGO stage 2-3. Secondary outcomes included incident AKI, kidney replacement therapy, and PICU mortality. Predictive performance was evaluated using ROC analysis and multivariable logistic regression. **Results:** A total of 314 children were included. Severe AKI developed in 56 (17.8%) patients. RAI showed good discrimination for severe AKI (AUC 0.790; 95% CI 0.741-0.834), with sensitivity of 78.6% and specificity of 70.5% at a cutoff of ≥8. For incident AKI, the AUC was 0.752 (95% CI 0.643-0.861). RAI outperformed serum creatinine and fluid overload in predicting severe AKI. RAI ≥ 8 remained independently associated with severe AKI (adjusted OR 7.40; 95% CI 2.51-21.78; p - [DOI](https://doi.org/10.1056/nejmoa1611391) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/27959707/) 2. 1. Selewski D, Cornell T, Heung M, Troost J et al (2014) Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 40:1481–1488. - [DOI](https://doi.org/10.1007/s00134-014-3391-8) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/25079008/) 3. 1. Basu R, Wang Y, Wong H, Chawla L, Wheeler D, Goldstein S (2014) Incorporation of biomarkers with the renal angina index for prediction of severe AKI in critically ill children. Clin J Am Soc Nephrol 9:654–662. - [DOI](https://doi.org/10.2215/cjn.09720913) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/24677554/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/3974366/) 4. 1. Sutherland SM, Zappitelli M, Alexander SR, Chua AN et al (2010) Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 55:316–325. - [DOI](https://doi.org/10.1053/j.ajkd.2009.10.048) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/20042260/) 5. 1. Matsuura R, Srisawat N, Claure-Del Granado R, Doi K, Yoshida T, Nangaku M, Noiri E (2018) Use of the Renal Angina Index in Determining Acute Kidney Injury. Kidney Int Rep 3:677–683. - [DOI](https://doi.org/10.1016/j.ekir.2018.01.013) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29854976/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/5976819/) Show all 19 references [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42909503/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42909503%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42909503/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42909503%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42909503%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42909503/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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