Kidney Disease Improving Global Outcomes or creatinine kinetics criteria in acute kidney injury: a proof of concept study

Libório, Alexandre Braga; Macedo, Etienne; Queiroz, Rafaela Elizabeth Bayas; Leite, Tacyano Tavares; Rocha, Inessa Carvalho Queiroz; Freitas, Ingrid Alves de; Corrêa, Larissa Chagas; Campelo, Camila Pontes Bessa; Araújo, Fabrícia Souza; Albuquerque, Cláudio Alves de; Arnaud, Frederico Carlos de Sousa; Sousa, Francisco Daniel de; Neves, Fernanda Macedo de Oliveira

doi:10.1093/ndt/gft375

Cited by 23 publications

(15 citation statements)

References 18 publications

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“…The association of creatinine-based KDIGO criteria and kGFR with AKI and adverse events in a cohort of STEMI patients has been studied [21]. In contrast to our findings, the authors found superior sensitivity of KDIGO criteria in diagnosing AKI and predicting adverse outcomes compared with kGFR.…”

Section: Discussioncontrasting

confidence: 98%

The clinical utility of kinetic glomerular filtration rate

O’Sullivan

Doyle

2016

Clin Kidney J

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Background: In acutely unwell patients with rapidly changing renal function, estimating glomerular filtration rate (GFR) and predicting adverse renal outcomes are challenging and often inaccurate. Kinetic GFR (kGFR) is an estimate of immediate biomarker clearance derived from two discreet measurements that may better represent acute function. Our objective is to assess the clinical utility of kGFR as a predictive tool and examine the association of kGFR to adverse renal outcomes compared with measurements to traditional estimates. Methods: We compared the association of kGFR and Modification of Diet in Renal Disease (MDRD) with acute kidney injury (AKI), renal replacement therapy (RRT), cardiovascular morbidity, 30-day mortality and new chronic kidney disease development. A total of 107 acute admissions to a medical high dependency and intensive care unit were assessed retrospectively. Creatinine measurements and outcomes were recorded and kGFR was calculated at the earliest possible time point. This was then compared with simultaneous MDRD estimated GFR. Results: Mean age was 60 years old, AKI occurred in 25% of patients, acute cardiovascular events occurred in 13%, RRT was initiated in 15% and 30-day mortality was 30%. kGFR predicted the AKI more accurately than MDRD [area under the receiver operating characteristic curve (AUC) = 0.86 versus AUC = 0.64]. kGFR predicted the need for RRT more accurately than MDRD (AUC = 0.901 versus AUC = 0.79). Neither kGFR nor admission MDRD was associated with 30-day mortality or cardiovascular morbidity. Conclusions: Measuring kGFR in the acute setting could help clinicians better predict adverse renal outcomes.

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Section: Discussioncontrasting

confidence: 98%

The clinical utility of kinetic glomerular filtration rate

O’Sullivan

Doyle

2016

Clin Kidney J

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“…Patients who do not meet RIFLE Risk stage criteria are included in KDIGO AKI stage 1. Thus, KDIGO classification is more sensitive to detect AKI [14]. Consequently, this increases the nephrotoxicity rate when KDIGO classification is preferred.…”

Section: Discussionmentioning

confidence: 99%

Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin

Çiftçi

İzdeş

Altıntaş

2018

J Infect Dev Ctries

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Introduction: We aimed to determine risk factors for nephrotoxicity and factors affecting mortality in patients who received colistin. Methodology: Critical patients who received colistin were enrolled. Pregnancy, age < 18 years, basal creatinine level > 2 mg/dL, colistin use for < 48 hours, and previous renal replacement therapy were exclusion criteria. KDIGO stages were determined according to creatinine levels. Patients were grouped as those with no acute kidney injury (Group N0) and those with acute kidney injury (Group N). Their demographic data, APACHE II and SOFA scores, treatments, and laboratory results were recorded. Results: A total of 91 patients were included: 27 in Group N0 and 64 in Group N. Demographic data were similar between groups; however, higher admission APACHE-II scores (OR:1.179, 95% CI:1.033-1.346, p = 0.015) and need for vasopressors (OR:5.486, 95% CI:1.522-19.769, p = 0.009) were found to be independent risk factors for nephrotoxicity. Higher APACHE II scores (OR:1.253, %95 CI:1.093-1.437, p = 0.001), presence of coronary artery disease (OR:7.720, % 95 CI: 1.613-36.956, p = 0.011), need for vasopressors (OR: 4.587, % 95 CI: 1.224 -17.241, p = 0.024), hypoalbuminemia (OR: 4.721, % 95 CI: 1.088 -20.469, p = 0.038), and higher direct bilirubin levels (OR: 1.806, % 95 CI: 1.055 -3.092, p = 0.031) were independent risk factors for mortality. Conclusion: When use of colistin is considered in ICU patients, presence of modifiable risk factors for nephrotoxicity such as hypoalbuminemia, nephrotoxic drug administration, and presence of shock should be determined and managed to prevent nephrotoxicity.

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“…Second, the 0.3-mg/dl absolute increase may not be appropriate to apply to those with elevated creatinine at baseline. Third, better use of readily available clinical data (such as those used by kinetic creatinine models [27,28] or integrating creatinine with other relevant laboratory values) may improve diagnostic and prognostic performance. Fourth, biomarkers with greater sensitivity and specificity than creatinine should continue to be developed, tested, and deployed.…”

Section: Discussionmentioning

confidence: 99%

False-Positive Rate of AKI Using Consensus Creatinine–Based Criteria

Lin¹,

Fernández

Shashaty

et al. 2015

Clinical Journal of the American Society of Nephrology

104

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Background and objectives Use of small changes in serum creatinine to diagnose AKI allows for earlier detection but may increase diagnostic false-positive rates because of inherent laboratory and biologic variabilities of creatinine.Design, setting, participants, & measurements We examined serum creatinine measurement characteristics in a prospective observational clinical reference cohort of 2267 adult patients with AKI by Kidney Disease Improving Global Outcomes creatinine criteria and used these data to create a simulation cohort to model AKI false-positive rates. We simulated up to seven successive blood draws on an equal population of hypothetical patients with unchanging true serum creatinine values. Error terms generated from laboratory and biologic variabilities were added to each simulated patient's true serum creatinine value to obtain the simulated measured serum creatinine for each blood draw. We determined the proportion of patients who would be erroneously diagnosed with AKI by Kidney Disease Improving Global Outcomes creatinine criteria.Results Within the clinical cohort, 75.0% of patients received four serum creatinine draws within at least one 48-hour period during hospitalization. After four simulated creatinine measurements that accounted for laboratory variability calculated from assay characteristics and 4.4% of biologic variability determined from the clinical cohort and publicly available data, the overall false-positive rate for AKI diagnosis was 8.0% (interquartile range =7.9%-8.1%), whereas patients with true serum creatinine $1.5 mg/dl (representing 21% of the clinical cohort) had a false-positive AKI diagnosis rate of 30.5% (interquartile range =30.1%-30.9%) versus 2.0% (interquartile range =1.9%-2.1%) in patients with true serum creatinine values ,1.5 mg/dl (P,0.001).Conclusions Use of small serum creatinine changes to diagnose AKI is limited by high false-positive rates caused by inherent variability of serum creatinine at higher baseline values, potentially misclassifying patients with CKD in AKI studies.

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Kidney Disease Improving Global Outcomes or creatinine kinetics criteria in acute kidney injury: a proof of concept study

Abstract: AKI classification proposed by a Cr kinetics model can be superior when diagnosing patients with previous CKD. However, KDIGO had a better performance in patients with no previous CKD.

Cited by 23 publications

References 18 publications

The clinical utility of kinetic glomerular filtration rate

The clinical utility of kinetic glomerular filtration rate

Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin

False-Positive Rate of AKI Using Consensus Creatinine–Based Criteria

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