Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors

Abstract

Background Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is defined as the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 persisting for more than 90 days. We compared CKD incidence using both creatinine- and cystatin C-based GFR with AKD incidence at 90 days in AKI survivors. Methods A prospective cohort study was conducted in a Swedish intensive care unit (ICU) between 2008 and 2010. We included AKI patients alive at 90 days. We excluded patients <18 and >100 years, death before follow-up, CKD prior to admission, and follow-up before 60 days or beyond 270 days. Creatinine and cystatin C were measured at 90 days and converted to eGFR (mL/min/1.73 m2). Results We included 274 patients. At 90-day follow-up, the median creatinine eGFR (MDRD) was 81.6 (IQR 58.6–106.8) and median cystatin C eGFR was 51.5 (IQR 35.8–70.7). The incidence of CKD (eGFR < 60) was 25.8% based on creatinine but 63.7% using cystatin C estimates. AKD was present in 47 patients (18.9%). Age, discharge cystatin C, creatinine at discharge, and female gender predicted creatinine-defined CKD at follow-up. Age, discharge cystatin C, CRRT on ICU, and diabetes were associated with cystatin C-based CKD. Conclusions In AKI survivors followed up at 3 months, CKD criteria were met in a quarter of patients using creatinine and in two-thirds using cystatin C eGFR. Less than one-fifth of patients fulfilled AKD criteria. The application of AKD criteria may underestimate renal dysfunction in AKI survivors.

Continuous renal replacement therapy in intensive care patients with COVID-19; survival and renal recovery

“…Much emphasis has been given to the potentially differing pathophysiological process occurring during COVID-19 AKI, which may include microthrombi formation, renal congestion secondary to right ventricular failure and direct viral injury. This study cannot elucidate on the mechanism of AKI, but does suggest a clear reversibility and recovery is comparable to that seen in AKI patients with different aetiologies, such as our previously reported mixed ICU cohort, where AKD incidence was 18.9% [ 17 ].…”

“…The weight loss experienced by survivors is an important finding because it has implications for patient's rehabilitation and the interpretation of their post COVID renal function test, where sarcopenia may result in low creatinine values and lead to falsely high GFR estimates, if based on serum creatinine measurements alone [ 17 , 23 ].…”

Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference

“…Cystatin C is less reliant on muscle mass and dietary intake and offers an alternative approach to estimate GFR. Reports indicate that in a steady state, eGFR estimated by creatinine–cystatin C is more precise and accurate at determining a measured GFR than eGFR estimated by creatinine or cystatinC alone . The use of CKD Epidemiology Collaboration (CKD-EPI) eGFR including creatinine and cystatin C in a vancomycin dosing algorithm improved the achievement of target vancomycin trough concentrations by 22% compared with historical controls using CKD-EPI eGFR estimated with creatinine alone .…”

“…Reports indicate that in a steady state, eGFR estimated by creatinine-cystatin C is more precise and accurate at determining a measured GFR than eGFR estimated by creatinine or cystatin C alone. 8,57 The use of CKD Epidemiology Collaboration (CKD-EPI) eGFR including creatinine and cystatin C in a vancomycin dosing algorithm improved the achievement of target vancomycin trough concentrations by 22% compared with historical controls using CKD-EPI eGFR estimated with creatinine alone. [58][59][60] For life-saving drugs with potential nephrotoxic effects, the concomitant use of functional and damage biomarkers has the potential to provide important information to gauge dosing and duration of treatment and to prevent AKI.…”

Disease Network Delineates the Disease Progression Profile of Cardiovascular Diseases

“…For example, urea nitrogen and creatinine are identified as key features in the risk model for the hyperlipidemia-CKD (Chronic kidney disease) pair, which is consistent to the knowledge that these two features are usually used for glomerular filtration rate estimation (GFR) 35 . Though the GFR and cystatin C are important biomarkers for kidney disease 36 , these two features are filtered in our pipeline due to poor data abundance, indicating that parts of well-known features may not have sufficient data abundance in EHR data. Meanwhile, we also detected several important but rarely reported features, such as thyrotropin and hematocrit, which could be regarded as candidate biomarkers in the future studies.…”