Acute kidney injury in traumatic brain injury intensive care unit patients

Abstract

BACKGROUND The exact definition of Acute kidney injury (AKI) for patients with traumatic brain injury (TBI) is unknown. AIM To compare the power of the “Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease” (RIFLE), Acute Kidney Injury Network (AKIN), Creatinine kinetics (CK), and Kidney Disease Improving Global Outcomes (KDIGO) to determine AKI incidence/stage and their association with the in-hospital mortality rate of patients with TBI. METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012, and 1648 patients were included. The subjects in this study were assessed for the presence and stage of AKI using RIFLE, AKIN, CK, and KDIGO. In addition, the propensity score matching method was used. RESULTS Among the 1648 patients, 291 (17.7%) had AKI, according to KDIGO. The highest incidence of AKI was found by KDIGO (17.7%), followed by AKIN (17.1%), RIFLE (12.7%), and CK (11.5%) ( P = 0.97). Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3% for stage 0, 36.0%/91.5%/44.5% for stage 1, 35.9%/90.6%/11.3% for stage 2, and 47.4%/89.5%/36.8% for stage 3. The in-hospital mortality rates increased with the AKI stage in all four definitions. The severity of AKI by all definitions and stages was not associated with in-hospital mortality in the multivariable analyses (all P > 0.05). CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages. This study revealed that KDIGO is the best method to define AKI in patients with TBI.

Acute kidney injury in neurocritical care

“…While insights into AKI incidence among neurocritical patients mainly stem from retrospective studies in single centers and exclude cases diagnosed with AKI upon admission, a recent study in a mixed neurological/neurosurgical ICU reported an overall AKI occurrence of 23.5% utilizing the SCr/UOP KDIGO criteria [ 9 ]. Interestingly, similar AKI rates were noted among specific brain pathologies, including TBI, 11.9–26.7% (KDIGO, SCr only) [ 10 – 14 ] and 17.7% (SCr/UOP KDIGO) [ 15 ]; acute stroke, 20.9–43.3% (KDIGO, SCr only) [ 16 , 17 ]; non-traumatic aneurysmal SAH, 16.7–23.7% (KDIGO, SCr only) [ 18 , 19 ], and ICH, 20.0–29.9% [ 18 , 20 – 22 ]. The few studies assessing RRT in patients with ABI reported overall rates of 0.3–5.6% among neurocritical patients [ 17 , 23 ].…”