Acute Kidney Injury Classification for Critically Ill Cirrhotic Patients: A Comparison of the KDIGO, AKIN and RIFLE Classifications

Abstract

Critically ill cirrhotic patients have high mortality rates, particularly when they present with acute kidney injury (AKI) on admission. The Kidney Disease: Improving Global Outcomes (KDIGO) group aimed to standardize the definition of AKI and recently published a new AKI classification. However, the efficacy of the KDIGO classification for predicting outcomes of critically ill cirrhotic patients is unclear. We prospectively enrolled 242 cirrhotic patients from a 10-bed specialized hepatogastroenterology intensive care unit (ICU) in a 2000-bed tertiary-care referral hospital. Demographic parameters and clinical variables on day 1 of admission were prospectively recorded. The overall in-hospital mortality rate was 62.8%. Liver diseases were usually attributed to hepatitis B viral infection (26.9%). The major cause of ICU admission was upper gastrointestinal bleeding (38.0%). Our result showed that the KDIGO classification had better discriminatory power than RIFLE and AKIN criteria in predicting in-hospital mortality. Cumulative survival rates at the 6-month after hospital discharge differed significantly between patients with and without AKI on ICU admission day. In summary, we identified that the outcome prediction performance of KDIGO classification is superior to that of AKIN or RIFLE classification in critically ill cirrhotic patients.

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

“…18 The recent Kidney Disease Improving Global Outcome (KDIGO) classification combines the AKI definition of the risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE) and AKI network (AKIN) classifications and its superior diagnostic accuracy and prediction of adverse outcomes has been proven in cirrhotic patients. [19][20][21] The KDIGO classification accurately detects minor variations in SCr values which have been associated with poor prognosis in cirrhotic patients. 18,22,23 In addition, AKI superimposed on previous renal dysfunction confers a higher risk for mortality.…”

A nationwide survey of clinical characteristics, management, and outcomes of acute kidney injury (AKI) – patients with and without preexisting chronic kidney disease have different prognoses

“…KDIGO classification aimed to standardize the definition of AKI and facilitate advances in the clinical practice and research. [44] However, the influence of urine criteria and preexisting CKD on KDIGO-AKI staging has yet to be extensively described in the literature. [9,12,14,45–48] Our study highlighted the contribution of urine criteria and the impact of preexisting CKD for the current AKI definition.…”

Acute kidney injury in critically ill cirrhotic patients with spontaneous bacterial peritonitis: a comparison of KDIGO and ICA criteria

“…The last serum creatinine within the previous 3 months before hospitalization was used as the baseline serum creatinine. In patients without previous serum creatinine, the first serum creatinine during hospitalization was used [8,17]. A predictive model for hospital mortality was applied as follows: non-AKI (0 points); ICA stage 1, and KDIGO stage 1 (1 point); ICA stage 2, and KDIGO stage 2 (2 points); ICA stage 3, and KDIGO stage 3 (3 points).…”