Classifying AKI by Urine Output versus Serum Creatinine Level

Kellum, John A.; Sileanu, Florentina E.; Murugan, Raghavan; Lucko, Nicole; Shaw, Andrew; Clermont, Gilles

doi:10.1681/asn.2014070724

Cited by 435 publications

(390 citation statements)

References 19 publications

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“…Serial daily weights would have been more useful, but unfortunately these data are not available. Similar to data [9,10] reported in adults, oliguria at both the start and at the end of CRRT was a poor prognostic factor and was associated with mortality.…”

supporting

confidence: 84%

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

2016

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Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults. In addition, ultrafiltration often cannot be set in sufficiently small increments to be suitable for neonates. Although CRRT practices can be modified to fit the needs of infants and neonates, there is a need for a device designed specifically for this population. Until that becomes available, providing the highest level of care for neonates with AKI is dependent on the shared experiences of members of the pediatric nephrology community.Keywords Extracorporeal continuous renal replacement therapy . Acute kidney injury . Neonates . nRIFLE . Continuous venovenous hemodiafiltrationIn a recent article in Pediatric Nephrology, Lee and Cho review their continuous renal replacement therapy (CRRT) experience in 34 neonates with acute kidney injury (AKI) [1]. Although single center and retrospective, there are several noteworthy characteristics of this study. The authors standardize neonatal AKI using the neonatal RIFLE (nRIFLE) criteria to define and stratify severity of AKI. Of the 34 neonates included in the study, 44 % were born preterm (25-36 weeks), with 60 % of these preterm infants being either extremely or very low birth weight. All patients had AKI, and 24 patients met the nRIFLE class F (Failure) criterion. Survival was 50 %. Continuous venovenous hemodiafiltration (CVVHDF) with Prisma or Prismaflex (Gambro/Baxter Int., Lund, Sweden) dialysis machines and M10 (50 ml) or HF20 (55 ml) filters was used for all CRRT treatments. Access was via internal jugular 6.5-French (Fr) hemodialysis catheters. Mean filter life was 51.1 h. Similar to other studies in pediatric CRRT patients [2-4, 5], fluid overload (FO), defined by the percentage weight gain over weight at admission to the neonatal intensive care unit (NICU), was independently associated with mortality [6]. Neonatal studies have reported an FO of >15-20 % to be associated with poor outcome defined as need for CRRT, prolonged NICU stay, time to extubation or death within 30 days postcardiothoracic surgery [7,8]. Interestingly, this study by Lee and Cho [1] reports a much higher FO cut-off of 30 % being associated with poor outcomes, including 100 % mortality for patients reaching an FO of >30 %. The authors propose higher body surface area, calorie consumption and insensible water loss in neonates as a possible explanation. They address this issue by using actual weig...

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supporting

confidence: 84%

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

2016

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“…Regardless of disease severity, these studies demonstrate that complete and sustained reversal of an AKI episode within 48-72 h of its onset is associated with better outcomes than longer durations of AKI [10][11][12][13][14][15] . Based on the available data and expert opinion, the workgroup proposes using 48 h to define rapid reversal of AKI…”

Section: Persistent Aki Transient Versus Persistent Akimentioning

confidence: 77%

“…Although previous studies have relied primarily on serum creatinine to identify AKI, the workgroup recommends also using urine output criteria as recommended by KDIGO 5 . The importance of urine output criteria in defining persistent AKI was confirmed in a 2015 study of 32,045 critically ill patients, which demonstrated that short-term and long-term risk of death or RRT is greatest for patients who meet both the serum creatinine and urine output criteria for AKI and experience these abnormalities for longer than 3 days 12 .…”

Section: Persistent Aki Transient Versus Persistent Akimentioning

confidence: 98%

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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“…In current clinical practice, the diagnosis and classification of AKI stages relies on serum creatinine, glomerular filtration rate (GFR), and urine output 1.…”

Section: The Necessity Of Early Biomarkers In Acute Kidney Injury Andmentioning

confidence: 99%

Neutrophil Gelatinase‐Associated Lipocalin as a Biomarker of Allograft Function After Renal Transplantation: Evaluation of the Current Status and Future Insights

et al. 2017

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Neutrophil gelatinase‐associated lipocalin (NGAL), a protein belonging to the lipocalin superfamily initially found in activated neutrophils, is expressed by several cell types, including kidney tubule. The increase in NGAL production and release from tubular cells in response to various insults has been proven to predict acute kidney injury (AKI). For this reason, it has emerged as a valuable noninvasive biomarker of AKI in clinical nephrology. Also in the renal transplant setting, different studies have indicated NGAL as a valuable tool, especially in the early postoperative period, since the currently available clinical and laboratory parameters remain poorly sensitive to monitor immediate posttransplant graft function. This is an analysis of the recent literature to assess the utility of plasma and urinary NGAL, exosomal mRNA for NGAL, and NGAL levels in the perfusate of machine‐perfused kidneys for the prediction of graft function recovery in the early postsurgery phase after renal transplantation. We found that NGAL appears as a promising troponin‐like biomarker to detect short‐term impairment of graft function after renal transplant, but there are still some limitations in its clinical application, essentially related to its low specificity. Moreover, comparing NGAL assayed in serum, urine, machine‐perfusate, or as exosomal mRNA, each one has shown limitations and benefits in terms of predictive performance for DGF, according to various existing studies, feasibly due to different cut‐off levels, designs and patient sample sizes.

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Classifying AKI by Urine Output versus Serum Creatinine Level

Cited by 435 publications

References 19 publications

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Neutrophil Gelatinase‐Associated Lipocalin as a Biomarker of Allograft Function After Renal Transplantation: Evaluation of the Current Status and Future Insights

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