The definition of acute kidney injury and its use in practice

Abstract

Acute kidney injury (AKI) is a common syndrome that is independently associated with increased mortality. A standardized definition is important to facilitate clinical care and research. The definition of AKI has evolved rapidly since 2004, with the introduction of the Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) classifications. RIFLE was modified for pediatric use (pRIFLE). They were developed using both evidence and consensus. Small rises in serum creatinine are independently associated with increased mortality, and hence are incorporated into the current definition of AKI. The recent definition from the international KDIGO guideline merged RIFLE and AKIN. Systematic review has found that these definitions do not differ significantly in their performance. Health-care staff caring for children or adults should use standard criteria for AKI, such as the pRIFLE or KDIGO definitions, respectively. These efforts to standardize AKI definition are a substantial advance, although areas of uncertainty remain. The new definitions have enabled the use of electronic alerts to warn clinicians of possible AKI. Novel biomarkers may further refine the definition of AKI, but their use will need to produce tangible improvements in outcomes and cost effectiveness. Further developments in AKI definitions should be informed by research into their practical application across health-care providers. This review will discuss the definition of AKI and its use in practice for clinicians and laboratory scientists.

Minor Postoperative Increases of Creatinine Are Associated With Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

“…The KDIGO AKI classification is the most recently published AKI classification, 27 merged Risk, Injury, Failure, Loss of kidney function, End-stage renal disease (RIFLE) and Acute Kindney Injury Network (AKIN) criteria, [28][29][30] and leads to the most frequent diagnosis of AKI. 31 Based on the maximum value of available postoperative creatinine, patients were categorized in mutually exclusive categories of creatinine change and corresponding stages of AKI according to the KDIGO definition, 27 including no follow-up (no F/U), no measured increase (ΔCr ≤ 0%), slight increase (ΔCr 1 to 24%), minor increase (ΔCr 25 to 49%), KDIGO stage 1 (ΔCr 50 to 99%, corresponding to RIFLE R or AKIN 1), KDIGO stage 2 (ΔCr 100 to 199%, RIFLE I or AKIN 2), and KDIGO stage 3 (ΔCr ≥ 200%, RIFLE F or AKIN 3).…”

Nursing Activities Score and Acute Kidney Injury

“…The KDIGO classification was developed with the purpose of refining the criteria for inclusion of the patients at each stage, which in the previous classifications presented difficulties in allocating some types of patients, especially those who started RRT (26) . In stages 2 and 3, the physiological complications were intensified (24)(25)(26) , which reflected an increased nursing workload to provide the necessary care, according to the patient acuity.…”

Identification and Recovery of Renal Function in Non-Dialytic Patients in The Intensive Therapy Scenario

“…Na clínica, o acompanhamento desses marcadores subsidia não apenas o controle de complicações, mas sinaliza a necessidade de implementar medidas preventivas precocemente. 9 Entre os sistemas de classificação, este estudo enfatizou o Acute Kidney Injury Network (AKIN) como indicador dos está-gios de acometimento renal (Tabela 1).…”