Identification and predicting short-term prognosis of early cardiorenal syndrome type 1: KDIGO is superior to RIFLE or AKIN.

Zhilian Li,Wei Shi,Shengli An,Zhiming Du,Yuanhan Chen,Lixia Xu,Xinling Liang,Ning Tan,Ruizhao Li,Lu Cai,Liwen Li

doi:10.1371/journal.pone.0114369

Abstract

ObjectiveAcute kidney injury (AKI) in patients hospitalized for acute heart failure (AHF) is usually type 1 of the cardiorenal syndrome (CRS) and has been associated with increased morbidity and mortality. Early recognition of AKI is critical. This study was to determine if the new KDIGO criteria (Kidney Disease: Improving Global Outcomes) for identification and short-term prognosis of early CRS type 1 was superior to the previous RIFLE and AKIN criteria.MethodsThe association between AKI diagnosed by KDIGO but not by RIFLE or AKIN and in-hospital mortality was retrospectively evaluated in 1005 Chinese adult patients with AHF between July 2008 and May 2012. AKI was defined as RIFLE, AKIN and KDIGO criteria, respectively. Cox regression was used for multivariate analysis of in-hospital mortality.ResultsWithin 7 days on admission, the incidence of CRS type 1 was 38.9% by KDIGO criteria, 34.7% by AKIN, and 32.1% by RIFLE. A total of 110 (10.9%) cases were additional diagnosed by KDIGO criteria but not by RIFLE or AKIN. 89.1% of them were in Stage 1 (AKIN) or Stage Risk (RIFLE). They accounted for 18.4% (25 cases) of the overall death. After adjustment, this proportion remained an independent risk factor for in-hospital mortality [odds ratios (OR)3.24, 95% confidence interval(95%CI) 1.97–5.35]. Kaplan-Meier curve showed AKI patients by RIFLE, AKIN, KDIGO and [K(+)R(−)+K(+)A(−)] had lower hospital survival than non-AKI patients (Log Rank P<0.001).ConclusionKDIGO criteria identified significantly more CRS type 1 episodes than RIFLE or AKIN. AKI missed diagnosed by RIFLE or AKIN criteria was an independent risk factor for in-hospital mortality, indicating the new KDIGO criteria was superior to RIFLE and AKIN in predicting short-term outcomes in early CRS type 1.

Highlights

Acute kidney injury (AKI) is common and one of the most powerful determinants of outcome in acute heart failure (AHF) [1,2,3]
AKI missed diagnosed by RIFLE or AKI Network (AKIN) criteria was an independent risk factor for in-hospital mortality, indicating the new Kidney Disease Improving Global Outcomes (KDIGO) criteria was superior to RIFLE and AKIN in predicting short-term outcomes in early cardiorenal syndrome (CRS) type 1
The most recent consensus definition proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Work Group in 2012 [11], harmonizing RIFLE and AKIN definitions, contains those individuals diagnosed as AKI but not by RIFLE or AKIN

Summary

Introduction

Acute kidney injury (AKI) is common and one of the most powerful determinants of outcome in acute heart failure (AHF) [1,2,3]. According to a recently published classification, AKI after hospitalization for AHF is usually characteristic of the acute (Type 1) cardiorenal syndrome (CRS) [4,5,6]. The first consensus classification of AKI, known as the RIFLE criteria, was defined based on a $50% increase in serum creatinine (SCr) level occurring over 1–7 days or the presence of oliguria for more than 6 hours [8]. The new KDIGO criterion was not yet widely validated It remains unclear whether the proportion of AKI diagnosed by KDIGO criteria but missed by RIFLE or AKIN is associated with an increased risk of death during hospitalization. We hypothesize that KDIGO is superior to RIFLE and AKIN criteria in predicting in-hospital mortality in the setting of early CRS type 1 (within 7 days on admission)

Methods

Results

Conclusion