Epidemiology and outcomes of acute kidney injury in critically ill surgical patients

Recovery from AKI in the critically ill: potential confounders in the evaluation

“…Whether the absence of AKI criteria or stricter definitions of recovery are more appropriate requires further investigation on the relationship of these definitions of recovery with longterm patient and kidney outcome. Imputation of baseline Screat in patients with unavailable baseline is proposed by both ADQI and KDIGO [28] and was actually used in several clinical trials on AKI recovery [4,16,17,23,25]. We noted that patients with unknown baseline Screat had less complete recovery when compared with those with available baseline.…”

“…These results highlight the need for a clear description of the included population (inclusion or exclusion of nonsurvivors, proportion of CKD, AKI severity, method used for baseline creatinine assessment, and proportion of patients with imputed baseline) in studies on this topic. Although one could argue that kidney outcome should be assessed in all AKI patients, the inclusion of nonsurvivors (as in [16,18,19,[22][23][24]26]) not only induces bias (as patients may not have had enough time to recover before they died) but being dead with recovered kidneys also has little significance from a patient's perspective. Since mortality increases with increasing AKI severity, exclusion of non-survivors mainly affects the recovery pattern of more severe forms of AKI.…”

“…The majority of the available studies reported recovery at hospital discharge [17,[19][20][21][22][23][24][25]. With the exception of studies focusing on long-term follow-up [4,5,10], recovery is mostly reported for all AKI patients (survivors and non-survivors) [15,16,18,19,[21][22][23]26]. Although inclusion of non-survivors is important from a pathophysiological point of view and essential for intervention trials, recovery of kidney function among survivors is probably more relevant from a patient's perspective and crucial for determining the burden of postdischarge nephrological follow-up.…”

“…The available clinical trials either excluded patients with an unknown baseline Screat [9,19], used an imputed baseline Screat based on the Modification of Diet in Renal Disease (MDRD) equation (as suggested by ADQI and KDIGO) [4,16,17,23,25], used the minimum Screat measured during hospitalization [5,21], or did not mention how baseline Screat was determined [18,24]. The impact of using an imputed instead of the observed baseline on the incidence of AKI has been reported [30][31][32].…”

Simple blood and urinary parameters measured at ICU admission may sign for AKI development in the early postoperative period: a retrospective, exploratory study

“…1,2 A high incidence of AKI (almost 50%) has been recently described in critically ill surgical patients. 2 AKI leads to increased intensive care unit (ICU) and hospital stay, increased costs, morbidity and mortality. 3 Hence, early AKI diagnosis remains a challenge which could help in its adequate management and improve prognosis.…”