Additional role of urine output criterion in defining acute kidney injury

Han, Seung Seok; Kang, Kyung Ja; Kwon, Soon Jung; Wang, Su Jung; Shin, Sun Hee; Oh, Se Won; Na, Ki Young; Chae, Dong Wan; Kim, Sejoong; Chin, Ho Jun

doi:10.1093/ndt/gfr312

Cited by 32 publications

(30 citation statements)

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“…11,12 Han and his colleagues reported that the percentage of AKI diagnosed by urine output criteria alone occurred between 2.9% and 25.7%, and their research reached 7.9%. 13,22 AKI has been well described in geriatric population, and an increased incidence of AKI becomes higher than previous studies (2-25%). 24 The proportion of AKI in these patients is 33.6% due to the use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) prior to surgical intervention.…”

Section: Discussionmentioning

confidence: 78%

“…19,20 Following the insufficiency of serum creatinine responsible for AKI, the next major quantum of deficiency in the field arose from the understanding that the limitations of the urine output criteria and inappropriately identifying prognostic factors of mortality in patients with AKI. 21,22 Because the factors including volume status and nutrition status that affect creatinine, serum creatinine was found to be subnormal standard biomarker for AKI. One report describe that plasma neutrophil gelatinase-associated lipocalin (NGAL) and serum cystatin C were better prognostic factors of AKI following cardiac surgery compared to serum creatinine.…”

Section: Discussionmentioning

confidence: 99%

“…Diuretics can elevate the amount of urine output but the discriminative function of urine output criteria is not changed for the survival rate calculations. 22 Second, those patients who were excluded due to no data of urine output probably made a selection bias. Not all the patients had the complete record of hourly urine output.…”

Section: Discussionmentioning

confidence: 99%

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The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Wang

Chen

et al. 2015

Renal Failure

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(2015) The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study, Renal Failure, 37:6,[985][986][987][988][989][990][991][992][993] CLINICAL STUDYThe association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study Objectives: The severity of acute kidney injury (AKI) has been a well-known predictor for inhospital mortality. Whether AKI duration could predict in-hospital mortality is not clear. This study determines the association between the in-hospital mortality and AKI duration in patients after non-cardiac surgery. Materials and methods: Surgical patients who were admitted to the ICU were enrolled. AKI cases were defined using KDIGO guidelines and categorized according to the tertiles of AKI duration (1st tertile: 2 days, 2nd tertile: 3-6 days and 3rd tertile: 7 days). The adjusted hazard ratios (HRs) for in-hospital mortality are compared to those without AKI. The predictability of mortality is accessed by calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve. Results: From a total of 318 postoperative patients, 98 developed AKI (1st tertile: 34 cases, 2nd tertile: 30 cases and 3rd tertile: 34 cases) and 220 had no AKI. The in-hospital mortality rates are 6.8% (non-AKI), 50% (1st tertile), 46.7% (2nd tertile) and 47% (3rd tertile). The HR's for in-hospital mortality are 7.92, 6.68 and 1.68, compared to the non-AKI group (p ¼ 0.006, 0.021 and 0.476). Cumulative in-hospital survival rates are significantly different for the non-AKI group and the AKI groups (p50.001). The AUC for AKI duration and stage together (0.804) is higher than that for AKI stage and AKI duration alone (0.803 and 0.777) (both ps50.001). Conclusion: In addition to severity, the duration of AKI may be a predictor of in-hospital mortality in patients, after non-cardiac surgery.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Wang

Chen

et al. 2015

Renal Failure

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“…The only effect this manipulation carried on our results was to potentially underestimate the change in eCCl from baseline • The worse part (either eCCl or FO) was used to stage AKI as in some cases Fluid overload was not known and only eCCl was used to stage AKI according to KDIGO guidelines. (few studies found no significant differences in RAI prediction of AKI when the outcome was based on creatinine or urine output 20 • We did not test the RAI on ICU admission days other than Day 0 or to predict AKI persistence after ICU Day 3 and acknowledge that the RAI performance may be better or worse than the clinical context we tested.…”

Section: Discussionmentioning

confidence: 99%

Validation of Renal Angina Index (RAI) to improve the prediction of Acute Kidney Injury (AKI) in critically ill children admitted to paediatric intensive care unit (PICU)

Jakanattane¹,

Sivakumar²,

Rajkumar³

et al. 2017

Int J Contemp Pediatr

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Background: Acute Kidney Injury (AKI) is associated with poor outcome in critically ill children. Reliable prediction of severe AKI may optimize treatment. Here we operationalize the concept of renal angina with Renal Angina Index (RAI). The objective of this study was to validate RAI for prediction of severe AKI on Day 3 of admission.Methods: A prospective observational study including children 1 month to 12 years admitted to PICU at ICH and RC, Madurai over 6 months. Clinical data, urine output (ml/kg/hour), serial S. creatinine values were collected. Renal angina positive was defined as RAI score ≥8.Results: Overall incidence of AKI was 27.8%. Day 0 RAI ≥8 was 42.9% of which 56.1% developed day 3 AKI. RAI ≤8 had high NPV of 93% for Day 3 AKI. Renal angina concept using RAI predicts subsequent severe AKI. RAI provides clinically feasible and applicable methodology to identify critically ill children at risk of severe AKI lasting beyond functional injury. RAI may potentially reduce capricious AKI biomarker use.Conclusions: The use of renal angina to stratify patients for enrollment in biomarker or therapy trials may create the uniformity required to properly analyze AKI in pediatric population. We believe that renal angina is a clinical adjunct that will lead to the optimization of AKI biomarker performance across the wide-ranging heterogeneity that exists across the general pediatric PICU population. RAI may potentially reduce capricious AKI biomarker use by identifying patients in whom further testing would be most beneficial.

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“…Recent studies have shown that UO is a sensitive and early marker for AKI in patients in the ICU and has additional roles in AKI staging (19,20). There is still controversy, however, about the application of UO criteria, especially in non-ICU patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of KDIGO Definitions in Patients with Histopathologic Evidence of Acute Renal Disease

Chu

Cui

Wang

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives AKI is a clinical syndrome with various causes involving glomerular, interstitial, tubular, and vascular compartments of the kidney. Acute kidney disease (AKD) is a new concept that includes both AKI and the conditions associated with subacute decreases in GFR (AKD/non-AKI). This study aimed to investigate the correlation between AKI/AKD defined by clinical presentation and diffuse histologic criteria for acute abnormalities based on renal biopsy.Design, setting, participants, & measurements All 303 patients who were histologically diagnosed as having acute tubular necrosis (ATN), acute tubulointerstitial nephritis, cellular crescentic GN, acute thrombotic microangiopathy, or complex lesions on renal biopsy from January 2009 to December 2011 were enrolled in the study. The 2012 Kidney Disease Improving Global Outcomes AKD/AKI definitions were applied to classify patients as follows: AKI, AKD/non-AKI, non-AKD, or unclassified.Results A total of 273 patients (90.1%) met the AKD criteria; 198 patients (65.3%) were classified as having AKI according to serum creatinine (SCr) and urine output criteria. The urine output criteria added 4.3% to the SCr criteria and reclassified 6.7% of the AKI cases into higher stages. Of patients with ATN on pathology, 79.2% met AKI criteria; this was a higher percentage than for those who had other individual pathologic lesions (50%-64%). The major cause of not being defined as having AKI was a slower SCr increase than that required by the definition of AKI (98, 93.3%). Patients with AKI had more severe clinical conditions and worse short-term renal outcome than those in the non-AKI group.Conclusions Diffuse, acute abnormality defined by renal biopsy and AKI defined by clinical presentation are two different entities. Most patients who have diffuse acute histologic findings met the criteria for AKD, whereas only two thirds met the definition of AKI.

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Additional role of urine output criterion in defining acute kidney injury

Abstract: Although some AKI cases were not identified by the UOCr alone, the UOCr has an additional role in AKI staging, regardless of diuretic use.

Cited by 32 publications

References 32 publications

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Validation of Renal Angina Index (RAI) to improve the prediction of Acute Kidney Injury (AKI) in critically ill children admitted to paediatric intensive care unit (PICU)

Assessment of KDIGO Definitions in Patients with Histopathologic Evidence of Acute Renal Disease

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