Comparison of Diagnostic Criteria for Acute Kidney Injury in Cardiac Surgery

Abstract

BackgroundThere is considerable controversy regarding the diagnosis of Acute Kidney Injury (AKI), and there are over 30 different definitions. ObjectiveTo evaluate the incidence and risk factors for the development of AKI following cardiac surgery according to the RIFLE, AKIN and KDIGO criteria, and compare the prognostic power of these criteria. MethodsCross-sectional study that included 321 consecutive patients (median age 62 [53-71] years; 140 men) undergoing cardiac surgery between June 2011 and January 2012. The patients were followed for up to 30 days, for a composite outcome (mortality, need for dialysis and extended hospitalization). ResultsThe incidence of AKI ranged from 15% - 51%, accordingly to the diagnostic criterion adopted. While age was associated with risk of AKI in the three criteria, there were variations in the remaining risk factors. During follow-up, 89 patients developed the outcome and all criteria were associated with increased risk in the univariate Cox analysis and after adjustment for age, gender, diabetes, and type of surgery. However, after further adjustment for extracorporeal circulation and the presence of low cardiac output, only AKI diagnosed by the KDIGO criterion maintained this significant association (HR= 1.89 [95% CI: 1.18 - 3.06]). ConclusionThe incidence and risk factors for AKI after cardiac surgery vary significantly according to the diagnostic criteria used. In our analysis, the KDIGO criterion was superior to AKIN and RIFLE with regard its prognostic power.

Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

“…The KDIGO criterion, published in 2012, was regarded as a complement to previous AKI definitions 32, 33. Sampaio et al compared the KDIGO AKI definition with AKIN and RIFLE criteria and validated its superiority, especially for prognoses in unstable hemodynamic cardiac surgery patients 34. Therefore, risk scores with the KDIGO AKI definition were better for predicting CSA‐AKI.…”

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

“…We excluded 268 studies: animal studies (15), reviews (42), no epidemiological data available (177), not about CRS-1 (23), no data about AKI or WRF (8) and studies evaluating a specific intervention (3). Finally, we included 64 papers (n = 509,766 patients), containing data on AKI in AHF patients (18 studies; 29,202 patients) [4,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], ACS (15 studies; 282,113 patients) [13,27,28,29,30,31,32,33,34,35,36,37,38,39,40] and CS (32 studies; 198,451 patients) [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72] (table 1). One study contained information about AHF as well as ACS and is therefore used in both groups [13].…”

Acute kidney injury in cardiac surgery

“…This made several practical refinements. The chronic criteria (loss and end-stage renal disease) as well as eGFR were discarded, decreasing the classification from five to three stages (AKIN Stages 1, 2, [41] declared the KDIGO criteria to be superior to AKIN and RIFLE with regard to prognostic power. This is also suggested by a single-center observational study in the general ICU population, where the KDIGO criteria demonstrated greater sensitivity to detect AKI and predict in-hospital mortality [42].…”