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A detailed evaluation of the new acute kidney injury criteria by KDIGO in critically ill patients

Journal of Anesthesia volume 30, pages 215–222 (2016)Cite this article

Abstract

Purpose

Two previous classifications of acute kidney injury (AKI) have shown that AKI is associated with increased mortality. In 2012, Kidney Disease Improving Global Outcomes (KDIGO) created new AKI criteria by combining the two previous classifications. However, such combination might cause inconsistency among each definition in the criteria. We have investigated all the definitions in the new KDIGO criteria.

Methods

We retrospectively studied 767 adult patients whose stay in the ICU exceeded 24 h. The KDIGO criteria were applied to all patients to diagnose AKI. Hospital mortality of patients with AKI diagnosed by the ten definitions in the criteria was compared.

Results

AKI occurred in 51.9 % with the standard definition of KDIGO. By multivariable analysis, odds ratios were increased with AKI stage progression and AKI stage 3 was significantly associated with hospital mortality. Crude hospital mortality stratified by the ten definitions showed increasing trends with stage progression. Mortality of the three definitions in stage 1 was from 4.0 to 10.8 %. Stage 2 had two definitions and their mortality was 13.6 and 17.6 %. Stage 3 had five definitions and their mortality ranged from 27.6 to 55.6 %.

Conclusion

AKI defined by the new KDIGO criteria was associated with increased hospital mortality. Although definitions in the KDIGO criteria seem to be appropriate because of the clear relationship between mortality and stage progression on the whole, several limitations may exist, especially in stage 3. Further research should be needed to clarify the validity of the KDIGO criteria and the detailed categories.

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Abbreviations

KDIGO:

Kidney Disease Improving Global Outcomes

AKI:

Acute kidney injury

RIFLE:

Risk, injury, failure, loss and end-stage kidney disease

AKIN:

Acute Kidney Injury Network

ICU:

Intensive care unit

ADQI:

Acute Dialysis Quality Initiative

APACHE:

Acute physiology and chronic health evaluation

MDRD:

Modification of diet in renal disease

CKD:

Chronic kidney disease

RRT:

Renal replacement therapy

ARDS:

Acute respiratory distress syndrome

AECC:

American-European consensus conference

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Acknowledgments

We thank the electronic medical record team in Jikei University School of Medicine for their contribution to this study. The authors declare no financial support or sponsorship.

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Affiliations

  1. Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan

    Junichi Izawa, Shigehiko Uchino & Masanori Takinami

Authors
  1. Junichi Izawa
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  2. Shigehiko Uchino
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  3. Masanori Takinami
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Corresponding author

Correspondence to Junichi Izawa.

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Izawa, J., Uchino, S. & Takinami, M. A detailed evaluation of the new acute kidney injury criteria by KDIGO in critically ill patients . J Anesth 30, 215–222 (2016). https://doi.org/10.1007/s00540-015-2109-6

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  • DOI: https://doi.org/10.1007/s00540-015-2109-6

Keywords

  • Critically ill
  • Acute kidney injury
  • Criteria
  • Observational study
  • Mortality