In FY16, the AWARE study (Assessment of Worldwide AKI, Renal angina and Epidemiology in children) —coordinated by the Cincinnati Children’s Center for Acute Care Nephrology (CACN) — was officially completed. This was the largest prospective, multinational study ever undertaken in pediatric critical care nephrology. The initial, groundbreaking findings — that acute kidney injury (AKI) is independently associated with increased mortality and morbidity in critically ill children — were published in the New England Journal of Medicine (NEJM) in November 2016. CACN representatives also presented results as an oral abstract at the 2016 American Society of Nephrology meeting.

In 2014, the AWARE study (Stuart Goldstein, MD, Principal Investigator) collected data from 5,297 patients admitted to 32 pediatric intensive care units in nine countries around the world. This first published manuscript describing the epidemiology of AKI in children and young adults revealed that 1.) AKI occurred in 26.9 percent of patients within seven days of ICU admission and 2.) severe AKI increased the risk of mortality by 77 percent, independent of 16 other co-variates.

Furthermore, AWARE was the first study to carefully assess both serum creatinine and urine output criteria for AKI in children. Importantly, it demonstrated that AKI based on decreased urine output carries a greater risk of mortality than AKI based on serum creatinine. Since children and young adults are generally free of the chronic co-morbidities such as diabetes, heart failure and cirrhosis that confound interpretation in adult studies, AWARE is a unique opportunity to demonstrate a direct role for AKI in mediating risk for morbidity and mortality.

Fourteen subsequent manuscripts are planned for the AWARE dataset. These will include the assessment of novel AKI biomarkers and the Renal Angina Index to improve early detection and prediction of severe AKI. For years to come, ongoing findings from this landmark study will serve as the benchmark and resource for developing diagnostic and therapeutic strategies to improve the outcomes for children with, or who are at risk for, acute kidney injury.