Creatinine Kinetics and the Definition of Acute Kidney Injury

Waikar, Sushrut S.; Bonventre, Joseph V.

doi:10.1681/asn.2008070669

Cited by 543 publications

(379 citation statements)

References 27 publications

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“…The Acute Kidney Injury Network (AKIN) criteria (16) modified RIFLE by incorporating an absolute increase in creatinine after the finding that small increases in serum creatinine (SCr) were of prognostic significance (1). In 2009, Waikar and Bonventre proposed a creatinine kinetics (CK)-based definition of AKI using absolute changes in SCr over 24 hours or 48 hours (17). Finally, in 2012, the Kidney Disease Improving Global Outcomes (KDIGO) Work Group proposed another definition that builds upon the AKIN definition (18).…”

Section: Introductionmentioning

confidence: 99%

Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals

Zeng

McMahon

Brunelli³

et al. 2014

Clinical Journal of the American Society of Nephrology

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358

252

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SummaryBackground and objectives At least four definitions of AKI have recently been proposed. This study sought to characterize the epidemiology of AKI according to the most recent consensus definition proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group, and to compare it with three other definitions.Design, setting, participants, & measurements This was a retrospective cohort study of 31,970 hospitalizations at an academic medical center in 2010. AKI was defined and staged according to KDIGO criteria, the Acute Dialysis Quality Initiative's RIFLE criteria, the Acute Kidney Injury Network (AKIN) criteria, and a definition based on a model of creatinine kinetics (CK). Outcomes of interest were incidence, in-hospital mortality, length of stay, costs, readmission rates, and posthospitalization disposition.Results AKI incidence was highest according to the KDIGO definition (18.3%) followed by the AKIN (16.6%), RIFLE (16.1%), and CK (7.0%) definitions. AKI incidence appeared markedly higher in those with low baseline serum creatinine according to the KDIGO, AKIN, and RIFLE definitions, in which AKI may be defined by a 50% increase over baseline. AKI according to all definitions was associated with a significantly higher risk of death and higher resource utilization. The adjusted odds ratios for in-hospital mortality in those with AKI were highest with the CK definition (5.2; 95% confidence interval [95% CI], 4.1 to 6.6), followed by the RIFLE (2.9; 95% CI, 2.2 to 3.6), KDIGO (2.8; 95% CI, 2.2 to 3.6), and AKIN (2.6; 95% CI, 2.0 to 3.3) definitions. Concordance in diagnosis and staging was high among the KDIGO, AKIN, and RIFLE definitions. ConclusionsThe incidence of AKI in hospitalized individuals varies depending on the definition used. AKI according to all definitions is associated with higher in-hospital mortality and resource utilization. AKI may be inappropriately diagnosed in those with low baseline serum creatinine using definitions that incorporate percentage increases over baseline.

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Section: Introductionmentioning

confidence: 99%

Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals

Zeng

McMahon

Brunelli³

et al. 2014

Clinical Journal of the American Society of Nephrology

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358

252

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“…It had the highest, statistically significant c statistic (0.78; P,0.001). We also found that the Waikar and Bonventre criteria, which defines AKI as a sCr increase of 0.3 mg/dl within the first 24 hours or a sCr increase of 0.5 mg/dl within the first 48 hours, performed well according to the NRI and IDI (Table 5) (22).…”

Section: Discussionmentioning

confidence: 55%

“…Subsequently, the net NRI and the IDI were calculated to further characterize the discriminatory ability of our criteria over various other definitions (Table 5). We found that our criteria and the Waikar and Bonventre criteria for AKI, in regard to NRI and IDI, performed equally well (P values of ,0.001 and ,0.001 for NRI and IDI, respectively, for both criteria) (22).…”

Section: Sustained Kidney Injury Is Better Predicted By Derived Critementioning

confidence: 64%

“…We then compared the performance of the criteria we derived to various other criteria used to characterize AKI to predict the risk of sustained kidney injury, such as the Acute Kidney Injury Network (AKIN); risk, injury, failure, loss, ESRD (RIFLE); and Waikar and Bonventre criteria (20)(21)(22). We used a .1.5-fold increase in sCr within 48 hours (RIFLE risk criteria) as our reference and compared the c statistics.…”

Section: Statistical Analysesmentioning

confidence: 99%

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Use of Postoperative Creatinine to Predict Sustained Kidney Injury in Patients Undergoing Mesothelioma Surgery

Mizuguchi

Mitani

Waikar

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives AKI leads to increased morbidity and mortality and progression to chronic kidney injury is a frequent consequence of AKI. Surgical treatment of mesothelioma is associated with increased risk for kidney injury. However, sustained kidney injury may limit therapeutic options for treating residual cancer. This study hypothesized that patients with significant serum creatinine (sCr) elevation within 48 hours of surgery would be at risk for sustained kidney injury. The goal was to determine the best acute sCr measure predictive of sustained kidney injury defined as a 50% increase in sCr from baseline measured 2-4 weeks after surgery.Design, setting, participants, & measurements In a prospective, observational cohort of surgical patients with mesothelioma, receiver operator characteristic curves were generated for the 24-and 48-hour absolute difference and relative sCr change over baseline in the derivation cohort (n=279). The prediction was tested in a validation cohort (n=207). The ability of various other AKI definitions to predict sustained kidney injury was evaluated.Results Sustained kidney injury occurred in 9.8% of patients in the derivation cohort. A $59% increase in sCr 48 hours after surgery was most predictive of sustained kidney injury (c statistic=0.78). Among other AKI definitions, a sCr increase of 0.3 mg/dl in 24 hours or 0.5 mg/dl increase in 48 hours (Waikar and Bonventre criteria) also reliably predicted sustained kidney injury.Conclusions Development of clinically significant sustained kidney injury can be predicted by acute postoperative sCr elevation in patients treated for mesothelioma.

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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

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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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Creatinine Kinetics and the Definition of Acute Kidney Injury

Cited by 543 publications

References 27 publications

Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals

Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals

Use of Postoperative Creatinine to Predict Sustained Kidney Injury in Patients Undergoing Mesothelioma Surgery

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

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