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Association between albumin-corrected anion gap level and the risk of acute kidney injury in intensive care unit

  • Nephrology - Original Paper
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Abstract

Purpose

This study was to investigate the association between albumin-corrected anion gap (AG) (ACAG) levels and the risk of acute kidney injury (AKI) in intensive care unit (ICU) patients.

Methods

The ICU patients of this retrospective cohort study were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2019. ACAG = AG + {4.4 − [albumin (g/dl)]} × 2.5. The incidence of AKI was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. The logistic regression model was used to evaluate the association between ACAG levels and the risk of AKI. Subgroup analyses were applied based on age, gender, mechanical ventilation, vasopressors, the Charlson comorbidity index (CCI), and the Simplified Acute Physiology Score II (SAPS II).

Results

Totally, 5586 patients were enrolled, of which 1929 patients (34.53%) occurred AKI. The higher levels of ACAG were associated with the risk of AKI in ICU patients, with the odds ratio (OR) value being 1.23 [95% confidence interval (CI): 1.22–1.24, P = 0.005] in ACAG level between 16.5 and 19.5, and OR value being 1.20 (95% CI 1.16–1.24, P = 0.016) in ACAG level > 19.5. A higher ACAG level was associated with a higher risk of AKI in ICU patients aged < 65 years, in ICU patients of female gender, in ICU patients who used mechanical ventilation, in ICU patients who did not use vasopressors, in patients without cardiogenic shock, and in ICU patients with CCI ≥ 2, and SAPS II > 31 (all P < 0.05).

Conclusion

There is an association between ACAG level and the risk of AKI in ICU patients. A higher ACAG value in ICU patients should therefore receive more attention.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Intensive Care Unit, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, 2 Hengbu Street, Liuhe Road, Xihu District, Hangzhou, 310023, People’s Republic of China

    Xi Zhao, Jiayu Han, Jianliang Hu, Zhilei Qiu & Siquan Zhang

  2. Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China

    Lihai Lu, Chunxiao Xia & Zihao Zheng

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  1. Xi Zhao
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Contributions

XZ and SZ designed the study. XZ wrote the manuscript. JH, JH, ZQ, LL, CX, and ZZ collected, analyzed, and interpreted the data. SZ critically reviewed, edited, and approved the manuscript. All authors read and approved the final manuscript.

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Correspondence to Siquan Zhang.

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Zhao, X., Han, J., Hu, J. et al. Association between albumin-corrected anion gap level and the risk of acute kidney injury in intensive care unit. Int Urol Nephrol 56, 1117–1127 (2024). https://doi.org/10.1007/s11255-023-03755-2

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