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The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: a validation study

Howitt, Samuel H.; Grant, Stuart W.; Caiado, Camila; Carlson, Eric; Kwon, Dowan; Dimarakis, Ioannis; Malagon, Ignacio; McCollum, Charles

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Authors

Samuel H. Howitt

Stuart W. Grant

Eric Carlson

Dowan Kwon

Ioannis Dimarakis

Ignacio Malagon

Charles McCollum



Abstract

Background The Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury (AKI) guidelines assign the same stage of AKI to patients whether they fulfil urine output criteria, serum creatinine criteria or both criteria for that stage. This study explores the validity of the KDIGO guidelines as a tool to stratify the risk of adverse outcomes in cardiac surgery patients. Methods Prospective data from consecutive adult patients admitted to the cardiac intensive care unit (CICU) following cardiac surgery between January 2013 and May 2015 were analysed. Patients were assigned to groups based on the criteria they met for each stage of AKI according to the KDIGO guidelines. Short and mid-term outcomes were compared between these groups. Results A total of 2267 patients were included with 772 meeting criteria for AKI-1 and 222 meeting criteria for AKI-2. After multivariable adjustment, patients meeting both urine output and creatinine criteria for AKI-1 were more likely to experience prolonged CICU stay (OR 4.9, 95%CI 3.3–7.4, p < 0.01) and more likely to require renal replacement therapy (OR 10.5, 95%CI 5.5–21.9, p < 0.01) than those meeting only the AKI-1 urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-1 were at an increased risk of mid-term mortality compared to those diagnosed with AKI-1 by urine output alone (HR 2.8, 95%CI 1.6–4.8, p < 0.01). Patients meeting both urine output and creatinine criteria for AKI-2 were more likely to experience prolonged CICU stay (OR 16.0, 95%CI 3.2–292.0, p < 0.01) or require RRT (OR 11.0, 95%CI 4.2–30.9, p < 0.01) than those meeting only the urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-2 were at a significantly increased risk of mid-term mortality compared to those diagnosed with AKI-2 by urine output alone (HR 3.6, 95%CI 1.4–9.3, p < 0.01). Conclusions Patients diagnosed with the same stage of AKI by different KDIGO criteria following cardiac surgery have significantly different short and mid-term outcomes. The KDIGO criteria need to be revisited before they can be used to stratify reliably the severity of AKI in cardiac surgery patients. The utility of the criteria also needs to be explored in other settings.

Citation

Howitt, S. H., Grant, S. W., Caiado, C., Carlson, E., Kwon, D., Dimarakis, I., …McCollum, C. (2018). The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: a validation study. BMC Nephrology, 19(1), Article 149. https://doi.org/10.1186/s12882-018-0946-x

Journal Article Type Article
Acceptance Date Jun 12, 2018
Online Publication Date Jun 25, 2018
Publication Date Jun 25, 2018
Deposit Date Jul 12, 2018
Publicly Available Date Mar 29, 2024
Journal BMC Nephrology
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 19
Issue 1
Article Number 149
DOI https://doi.org/10.1186/s12882-018-0946-x

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Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/

Copyright Statement
© The Author(s). 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.




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