The kinetic estimated glomerular filtration rate ratio predicts acute kidney injury

Abstract

Aim: Kinetic estimated Glomerular Filtration Rate (KeGFR) approximates GFR under non-steady-state conditions. We investigated whether the ratio of KeGFR difference to baseline eGFR could predict acute kidney injury (AKI) earlier than a creatininebased algorithm that triggered an AKI electronic Alert (eAlert).Methods: This retrospective, single-centre, proof-of-concept cohort study assessed all patients diagnosed with AKI by an automated serum creatinine-based eAlert. The kinetic eGFR, the kinetic eGFR difference from baseline and the ratio of difference to baseline was calculated in subjects with at least two serum creatinine (sCr) measurements within 72 h of AKI.Results: Patients in the AKI cohort (n = 140) had a significant decline in KeGFR ratio (AKI: 17% IQR 7% to 29%, Non-AKI: 0 IQR À12% to 9%; P-value <.0001). A decrease of the ratio greater than 10% predicted AKI with a sensitivity of 66%, a specificity of 77%, a positive predictive value of 63%, and negative predictive value of 80%. The median lead time between KeGFR ratio decrease and AKI was 24 h (IQR: 19-27 h).Conclusions: KeGFR ratio is a cheap, simple method that predicted AKI 24 h before laboratory detection. KeGFR may facilitate triaging patients to increased monitoring or intervention.

Acute Changes in Serum Creatinine and Kinetic Glomerular Filtration Rate Estimation in Early Phase of Acute Pancreatitis

“…Irrespective of the differences, the results of clinical observational studies [ 21 , 22 , 23 , 24 , 25 , 26 ] support the clinical utility of KeGFR in various patient populations with acutely changing serum creatinine and are in general agreement with our results. In 2015, Dewitte et al [ 21 ] published an analysis of 57 patients who developed AKI within 24 h of admission to ICU.…”

“…The idea behind the equation proposed by Chen was clearly described in his article [ 20 ] and the calculations were easy to adopt in clinical research. This equation was used to calculate KeGFR in observational clinical studies including patients treated in ICU [ 21 , 24 , 25 ], general hospital patients [ 26 ] and renal transplant recipients [ 22 , 23 ]; the same equation was used in our study. There are, however, some discrepancies in the use of the equation between the studies.…”

“…There was moderate concordance between the renal function assessed by KeGFR and AKI diagnosis and stages as defined by the KDIGO guidelines. Christiadi et al [ 26 ] evaluated KeGFR in 140 hospital patients with positive electronic AKI alert (i.e., serum creatinine results fulfilling the KDIGO [ 17 ] definition of AKI) and 242 control patients without AKI. The decrease in KeGFR of 8–10% or more was identified as an accurate marker of AKI.…”

“…Of those, the mathematically simplest formula of Chen [ 20 ] has been verified in several clinical studies involving patients of intensive care unit (ICU) [ 21 ] and renal transplant recipients [ 22 , 23 ]. In general, the clinical observational studies [ 21 , 22 , 23 , 24 , 25 , 26 ] supported the usefulness of KeGFR in the assessment of patients with acutely changing serum creatinine and suggested that KeGFR may improve drug dosing in such patients [ 27 ]. It has been postulated that evaluating GFR in patients with AKI would improve the assessment of patients in addition to laboratory markers of kidney tubular injury such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), or so-called cell cycle arrest biomarkers: tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) and insulin growth factor binding protein-7 (IGFBP-7) [ 28 ].…”

Reflections on the KDIGO Definition of Acute Kidney Injury and Its Integration in the Concept of Acute Diseases and Disorders and Chronic Kidney Diseases

“…Kinetic estimated GFR can be calculated to assess the trajectory of kidney function when SCr values are fluctuating [34,38]. Despite some inherent limitations, this method provides a more timely diagnosis, better appreciation of the severity of AKI, and detects renal recovery earlier (recovery of GFR while SCr is still increasing) [39][40][41][42][43]. Although a decrease in GFR is presently not included in the KDIGO AKI definition, this easy and cheap tool could become part of a future AKI definition [43].…”