Acute kidney injury after cardiac surgery according to Risk/Injury/Failure/Loss/End-stage, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes classifications

Bastin, Anthony J.; Ostermann, Marlies; Slack, Andrew; Diller, Gerhard‐Paul; Finney, Simon J.; Evans, Timothy W.

doi:10.1016/j.jcrc.2012.12.008

Cited by 164 publications

(143 citation statements)

References 29 publications

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“…16 A comparison of the performance of the three AKI classification systems in 1900 post-cardiac surgery patients showed that AKI incidence (25.9%) and staging were identical when using KDIGO and AKIN, while RIFLE identified fewest (24.9%) patients with AKI. 17 Similar findings were also reported in a study with 3100 critically ill patients. 5 KDIGO identified more patients with AKI than RIFLE (51% vs. 46.9%; p ¼ 0.001) or AKIN (51% vs. 38.4%; p < 0.001).…”

Section: Discussionsupporting

confidence: 84%

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

et al. 2016

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Purpose The objective of this study is to examine the incidence, clinical characteristics, and outcome (90-day mortality) of critically ill Chinese patients with septic AKI. Methods Patients admitted to the ICU of a regional hospital from 1 January 2011 to 31 December 2013 were included, excluding those on chronic renal replacement therapy. AKI was defined using KDIGO criteria. Patients were followed till 90 days from ICU admission or death, whichever occurred earlier. Demographics, diagnosis, clinical characteristics, and outcome were analyzed. Results In total, 3687 patients were included and 54.7% patients developed AKI. Sepsis was the most common cause of AKI (49.2%). Compared to those without AKI, AKI patients had higher disease severity, more physiological and biochemical disturbance, and carried significant co-morbidities. Ninety-day mortality increased with severity of AKI (16.7, 27.5, and 48.3% for KDIGO stage 1, 2, and 3 AKI, p < 0.001). Full renal recovery was achieved in 71.6% of AKI patients. Compared with non-septic AKI, septic AKI was associated with higher disease severity and required more aggressive support. Non-recovery of renal function occurred in 2.5% of patients with septic AKI, compared with 6.4% in non-septic AKI (p < 0.001). Cox regression analysis showed that age, emergency ICU admission, post-operative cases, admission diagnosis, etiology of AKI, disease severity score, mechanical ventilation, vasopressor support, and blood parameters (like albumin, potassium and pH) independently predicted 90-day mortality. Conclusions AKI, especially septic AKI is common in critically ill Chinese patients and is associated with poor patient outcome. Etiology of AKI has a significant impact on 90-day mortality and may affect renal outcome. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 84%

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

et al. 2016

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“…(23,(26)(27)(28). The RIFLE classification has exhibited good prognostic accuracy in terms of mortality in many intensive care unit studies (7-9) and several studies of hospital patients (4,6), and this finding was again confirmed in our study.…”

Section: Relationship To Previous Studiessupporting

confidence: 88%

“…The KDIGO classification keeps both the absolute increase in serum creatinine level of $0.3 mg/dl within 48 hours from the AKIN and the 7-day timeframe for the $50% increase from the RIFLE (Table 1). This newly published system has been recently assessed in several studies (23)(24)(25)(26)(27)(28). However, its application to in-hospital AKI and its prognostic accuracy compared with the two previous classifications have not been thoroughly evaluated.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Kidney Disease Improving Global Outcomes Criteria for AKI and Comparison of Three Criteria in Hospitalized Patients

Fujii

Uchino

Takinami

et al. 2014

Clinical Journal of the American Society of Nephrology

135

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Background and objectives AKI is a major clinical problem and predictor of outcome in hospitalized patients. In 2013, the Kidney Disease: Improving Global Outcomes (KDIGO) group published the third consensus AKI definition and classification system after the Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease (RIFLE) and the Acute Kidney Injury Network (AKIN) working group systems. It is unclear which system achieves optimal prognostication in hospital patients.Design, setting, participants, & measurements A retrospective observational study using hospital laboratory, admission, and discharge databases was performed that included adult patients admitted to a teaching hospital in Tokyo, Japan between April 1, 2008, and October 31, 2011. AKI occurring during each hospital stay was identified, and discriminative ability of each AKI classification system based on serum creatinine for the prediction of hospital mortality was assessed. The receiver operating characteristic curve, a graphical measure of test performance, and the area under the curve were used to evaluate how classifications preformed on the study population.Results In total, 49,518 admissions were studied, of which 11.0% were diagnosed with RIFLE criteria and 11.6% were diagnosed with KDIGO criteria, but only 4.8% were diagnosed with AKIN criteria. Overall hospital mortality was 3.0%. AKI staging and hospital mortality were closely correlated in all systems. Discrimination for hospital mortality was similar for RIFLE and KDIGO criteria (area under the curve=0.77 versus 0.78; P=0.02), whereas AKIN discrimination was inferior (area under the curve=0.69 versus RIFLE [P,0.001] versus KDIGO [P,0.001]).Conclusion Among hospital patients, KDIGO and RIFLE criteria achieved similar discrimination, but the discrimination of AKIN was inferior.

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“…A recent study performed with this method reported an incidence of 14% for AKI and showed that CSA-AKI aggravated short and long term outcomes in cardiac patients [19] . Nevertheless, a large survey of 1881 patients by Bastin et al [61] indicated that the incidence of AKI with both AKIN and RIFLE criteria was mostly equal (25.9% and 24.9%, respectively), but hospital mortality was predicted more precisely by AKIN. Another dispute was over the sensitivity of the two definitions insofar as whether or not the designated thresholds sufficiently diagnose all the cases of renal impairment.…”

Section: Aki Definition Systems: Rifle Akin and Kdigomentioning

confidence: 99%

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

Najafi

2014

WJC

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Serum creatinine is still the most important determinant in the assessment of perioperative renal function and in the prediction of adverse outcome in cardiac surgery. Many biomarkers have been studied to date; still, there is no surrogate for serum creatinine measurement in clinical practice because it is feasible and inexpensive. High levels of serum creatinine and its equivalents have been the most important preoperative risk factor for postoperative renal injury. Moreover, creatinine is the mainstay in predicting risk models and risk factor reduction has enhanced its importance in outcome prediction. The future perspective is the development of new definitions and novel tools for the early diagnosis of acute kidney injury largely based on serum creatinine and a panel of novel biomarkers.

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Acute kidney injury after cardiac surgery according to Risk/Injury/Failure/Loss/End-stage, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes classifications

Cited by 164 publications

References 29 publications

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

Septic acute kidney injury in critically ill patients – a single-center study on its incidence, clinical characteristics, and outcome predictors

Validation of the Kidney Disease Improving Global Outcomes Criteria for AKI and Comparison of Three Criteria in Hospitalized Patients

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

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