Journal Club

Abstract

Urine output (UO) criterion may increase the sensitivity of the definition of acute kidney injury (AKI). We determined whether the empirically derived definition for oliguria(<0.5 ml/kg/h) is independently associated with adverse outcome. Data analysis included hourly recorded UO from the prospective, multicenter FINNAKI study conducted in 16 Finnish intensive care units. Confounder-adjusted association of oliguria of different severity and duration primarily with the development of AKI defined by creatinine criterion (Cr-AKI) or renal replacement therapy(RRT) was assessed. Secondarily, we determined the association of oliguria with 90-day mortality. Of the 1966 patients analyzed for the development of AKI, 454 (23.1%) reached this endpoint. Within this AKI cohort, 312 (68.7%)developed Cr-AKI, 21 (4.6%) commenced RRT without Cr-AKI, and 121 (26.7%) commenced RRT with Cr-AKI. Episodes of severe oliguria (<0.1 ml/kg/h) for more than 3 h were independently associated with the development of Cr-AKI or RRT. The shortest periods of consecutive oliguria independently associated with an increased risk for 90-day mortality were 6–12 h of oliguria from 0.3 to <0.5 ml/kg/h, over 6 h of oliguria from 0.1 to <0.3 ml/kg/h, and severe oliguria lasting over 3 h.Thus, our findings underlie the importance of hourly UO measurements.

Fluid balance-adjusted creatinine at initiation of continuous venovenous hemofiltration and mortality. A post-hoc analysis of a multicenter randomized controlled trial.

“…In contrast to previous studies, urinary output [ 21 , 29 ] and days in ICU [ 6 ] were not related to mortality in our population. Urinary output may be confounded by the use of diuretics and oliguria does not necessarily implicate the presence of AKI [ 30 ].…”

The Japanese clinical practice guideline for acute kidney injury 2016

“…However, in a comparison of the sCr criterion alone with the urine output criterion alone for the diagnosis of AKI in patients after cardiac surgery, Lagny et al indicated that the use of the urine output criterion alone could lead to overdiagnosis [ 32 ]. In a recent multicenter prospective study that assessed the association between the hourly urine output and mortality, Vaara et al reported that patients who fulfilled both the sCr and urine output criteria had the highest rate of RRT initiation and the highest 90-day mortality, while isolated oliguria was associated with poor outcomes; these results affirm the importance of measuring the hourly urine output and the need to combine the urine output criterion with the sCr criterion [ 33 ]. Moreover, in using the urine output criterion in the diagnosis and staging of AKI, there is a concern that the use of diuretics may change the urine output, causing underestimation of the AKI severity.…”

Clinical Examination for the Prediction of Mortality in the Critically Ill: The Simple Intensive Care Studies-I

“…Data on the prognostic value of clinical examination findings are inconsistent. Previous studies have identified different predictors of mortality such as low blood pressure (6, 9, 10), oliguria (3, 5), prolonged capillary refill time (CRT) (11, 12), and skin mottling (4, 13). They often evaluated one or two clinical signs in isolation, instead of assessing a combination of signs and symptoms, which would more accurately reflect daily clinical practice.…”