TY - JOUR
T1 - Diagnosing acute kidney injury ahead of time in critically ill septic patients using kinetic estimated glomerular filtration rate
AU - Lijović, Lada
AU - Pelajić, Stipe
AU - Hawchar, Fatime
AU - Minev, Ivaylo
AU - da Silva, Beatriz Helena Cermaria Soares
AU - Angelucci, Alessandra
AU - Ercole, Ari
AU - de Grooth, Harm-Jan
AU - Thoral, Patrick
AU - Radočaj, Tomislav
AU - Elbers, Paul
N1 - Funding Information: Special thanks to Mihovil Kucijan for help with data extraction. Publisher Copyright: © 2023 The Authors
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Introduction: Accurate and actionable diagnosis of Acute Kidney Injury (AKI) ahead of time is important to prevent or mitigate renal insufficiency. The purpose of this study was to evaluate the performance of Kinetic estimated Glomerular Filtration Rate (KeGFR) in timely predicting AKI in critically ill septic patients. Methods: We conducted a retrospective analysis on septic ICU patients who developed AKI in AmsterdamUMCdb, the first freely available European ICU database. The reference standard for AKI was the Kidney Disease: Improving Global Outcomes (KDIGO) classification based on serum creatinine and urine output (UO). Prediction of AKI was based on stages defined by KeGFR and UO. Classifications were compared by length of ICU stay (LOS), need for renal replacement therapy and 28-day mortality. Predictive performance and time between prediction and diagnosis were calculated. Results: Of 2492 patients in the cohort, 1560 (62.0%) were diagnosed with AKI by KDIGO and 1706 (68.5%) by KeGFR criteria. Disease stages had agreement of kappa = 0.77, with KeGFR sensitivity 93.2%, specificity 73.0% and accuracy 85.7%. Median time to recognition of AKI Stage 1 was 13.2 h faster for KeGFR, and 7.5 h and 5.0 h for Stages 2 and 3. Outcomes revealed a slight difference in LOS and 28-day mortality for Stage 1. Conclusions: Predictive performance of KeGFR combined with UO criteria for diagnosing AKI is excellent. Compared to KDIGO, deterioration of renal function was identified earlier, most prominently for lower stages of AKI. This may shift the actionable window for preventing and mitigating renal insufficiency.
AB - Introduction: Accurate and actionable diagnosis of Acute Kidney Injury (AKI) ahead of time is important to prevent or mitigate renal insufficiency. The purpose of this study was to evaluate the performance of Kinetic estimated Glomerular Filtration Rate (KeGFR) in timely predicting AKI in critically ill septic patients. Methods: We conducted a retrospective analysis on septic ICU patients who developed AKI in AmsterdamUMCdb, the first freely available European ICU database. The reference standard for AKI was the Kidney Disease: Improving Global Outcomes (KDIGO) classification based on serum creatinine and urine output (UO). Prediction of AKI was based on stages defined by KeGFR and UO. Classifications were compared by length of ICU stay (LOS), need for renal replacement therapy and 28-day mortality. Predictive performance and time between prediction and diagnosis were calculated. Results: Of 2492 patients in the cohort, 1560 (62.0%) were diagnosed with AKI by KDIGO and 1706 (68.5%) by KeGFR criteria. Disease stages had agreement of kappa = 0.77, with KeGFR sensitivity 93.2%, specificity 73.0% and accuracy 85.7%. Median time to recognition of AKI Stage 1 was 13.2 h faster for KeGFR, and 7.5 h and 5.0 h for Stages 2 and 3. Outcomes revealed a slight difference in LOS and 28-day mortality for Stage 1. Conclusions: Predictive performance of KeGFR combined with UO criteria for diagnosing AKI is excellent. Compared to KDIGO, deterioration of renal function was identified earlier, most prominently for lower stages of AKI. This may shift the actionable window for preventing and mitigating renal insufficiency.
KW - Acute kidney injury
KW - Early detection
KW - Glomerular filtration rate
KW - Kinetic eGFR
UR - http://www.scopus.com/inward/record.url?scp=85147703020&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2023.154276
DO - https://doi.org/10.1016/j.jcrc.2023.154276
M3 - Article
C2 - 36774818
SN - 0883-9441
VL - 75
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154276
ER -