Challenges of defining acute kidney injury.
نویسندگان
چکیده
BACKGROUND Until recently, there was a lack of a uniform definition for acute kidney injury (AKI). The 'acute renal injury/acute renal failure syndrome/severe acute renal failure syndrome' criteria, the Risk - Injury - Failure - Loss of kidney function - End stage renal disease (RIFLE) criteria and the Acute Kidney Injury Network (AKIN) classification were the most recent proposals. AIM To compare the performance of the different AKI definitions. DESIGN AND METHODS Application of the three most recent AKI definitions to 41 972 critically ill ICU patients and comparison of their performance. RESULTS Incidence and outcome of AKI varied depending on the criteria. The RIFLE and AKIN classification led to similar total incidences of AKI (35.9 vs. 35.4%) but different incidences and outcomes of the individual AKI stages. Multivariate analysis showed that the different stages of AKI were independently associated with mortality. The worst stage of AKI was associated with an increased odds ratio for mortality of 1.59-2.27. Non-surgical admission, maximum number of associated failed organ systems, emergency surgery and mechanical ventilation were consistently associated with the highest risk of hospital mortality. The proposed AKI definitions differ in the cut-off values of serum creatinine, the suggested time frame, the approach towards patients with missing baseline values and the method of classifying patients on renal replacement therapy. All classifications can miss patients with definite AKI. CONCLUSION The three most recent definitions of AKI confirmed a correlation between severity of AKI and outcome but have limitations and the potential to miss patients with definite AKI. These limitations need to be considered when using the criteria in clinical practice.
منابع مشابه
Risk Factors of Acute Kidney Injury in Patients with Sepsis; A Cross-Sectional Study
Background and Objective: Due to the importance of acute kidney injury associated in patients with sepsis and the impact of various factors on mortality and hospital stay of these patients, this study was conducted to investigate the clinical features and risk factors for acute kidney injury in patients with sepsis. In addition, we examined whether the severity of acute kidney injury affected c...
متن کاملMonitoring and treatment of acute kidney injury in children with acute lymphoblastic leukemia after high dose methotrexate chemotherapy
Abstact：objective To investigate acute kidney injury (AKI) in children with acute lymphoblastic leukemia (ALL) who received high dose methotrexate (MTX) chemotherapy and explore the corresponding treatment. Methods 180 children who received high dose MTX chemotherapy were observed with serum MTX concentration and serum creatinine. Patients with AKI of stage 3 or poor response to conventional tr...
متن کاملMonitoring and treatment of acute kidney injury in children with acute lymphoblastic leukemia after high dose methotrexate chemotherapy
Abstact：objective To investigate acute kidney injury (AKI) in children with acute lymphoblastic leukemia (ALL) who received high dose methotrexate (MTX) chemotherapy and explore the corresponding treatment. Methods 180 children who received high dose MTX chemotherapy were observed with serum MTX concentration and serum creatinine. Patients with AKI of stage 3 or poor response to conventional tr...
متن کاملAcute Kidney Injury, Myocardial Infarction and Death Following Brake Fluid Poisoning; A Case Report
Background: Ethylene glycol is a toxic alcohol which is used in brake fluid, antifreeze, coolants, preservatives and chemical solvents. Ethylene glycol poisoning usually results in depression of the central nervous system, renal insufficiency and cardiopulmonary compromise, while laboratory findings include metabolic acidosis, increased anion gap, increased osmolar gap and calcium oxalate cryst...
متن کاملDifferent Biomarkers of Acute kidney Injury in Cancer Patients
Acute Kidney Injury (AKI) occurs if the kidneys suddenly lose their ability to remove waste products. When the kidneys lose their ability to filter, dangerous levels of waste products can accumulate, which can upset the chemical composition of the blood and urine. Chemotherapy is one of the methods used to treat or temporarily reduce cancer by using certain medications. The main task of this tr...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- QJM : monthly journal of the Association of Physicians
دوره 104 3 شماره
صفحات -
تاریخ انتشار 2011