Abstract
BackgroundKDIGO (Kidney Disease: Improving Global Outcomes) provides two sets of criteria to identify and classify acute kidney injury (AKI): serum creatinine (SCr) and urine output (UO). Inconsistencies in the application of KDIGO UO criteria, as well as collecting and classifying UO data, have prevented an accurate assessment of the role this easily available biomarker can play in the early identification of AKI.Study goalTo assess and compare the performance of the two KDIGO criteria (SCr and UO) for identification of AKI in the intensive care unit (ICU) by comparing the standard SCr criteria to consistent, real-time, consecutive, electronic urine output measurements.MethodsNinety five catheterized patients in the General ICU (GICU) of Hadassah Medical Center, Israel, were connected to the RenalSense™ Clarity RMS™ device to automatically monitor UO electronically (UOelec). UOelec and SCr were recorded for 24–48 h and up to 1 week, respectively, after ICU admission.ResultsReal-time consecutive UO measurements identified significantly more AKI patients than SCr in the patient population, 57.9% (N = 55) versus 26.4% (N = 25), respectively (P < 0.0001). In 20 patients that had AKI according to both criteria, time to AKI identification was significantly earlier using the UOelec criteria as compared to the SCr criteria (P < 0.0001). Among this population, the median (interquartile range (IQR)) identification time of AKI UOelec was 12.75 (8.75, 26.25) hours from ICU admission versus 39.06 (25.8, 108.64) hours for AKI SCr.ConclusionApplication of KDIGO criteria for AKI using continuous electronic monitoring of UO identifies more AKI patients, and identifies them earlier, than using the SCr criteria alone. This can enable the clinician to set protocol goals for earlier intervention for the prevention or treatment of AKI.
Highlights
KDIGO (Kidney Disease: Improving Global Outcomes) provides two sets of criteria to identify and classify acute kidney injury (AKI): serum creatinine (SCr) and urine output (UO)
Identification of AKI A total of 60 out of the 95 (63.2%) patients in the study group were identified with AKI, applying the KDIGO criteria, using either SCr or UO electronically (UOelec) or both criteria (Fig. 2)
AKI UOelec was identified in 57.9% (N = 55) of the patient population and AKI SCr was identified in 26.4% (N = 25) of the patient population
Summary
KDIGO (Kidney Disease: Improving Global Outcomes) provides two sets of criteria to identify and classify acute kidney injury (AKI): serum creatinine (SCr) and urine output (UO). Study goal: To assess and compare the performance of the two KDIGO criteria (SCr and UO) for identification of AKI in the intensive care unit (ICU) by comparing the standard SCr criteria to consistent, real-time, consecutive, electronic urine output measurements. Studies using the KDIGO (Kidney Disease: Improving Global Outcomes) criteria have identified acute kidney injury (AKI) in up to 75% of critically ill hospitalized patients [1]. In the intensive care unit (ICU) neither of these indicators for AKI provides timely information about kidney injury. They are dependent on the times when SCr or UO is manually measured and recorded by the medical staff. SCr levels increase only after approximately 50% loss of renal function, and is recognized as a late indicator for kidney injury [5,6,7]
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