Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Dec 26;9(12):e114369.
doi: 10.1371/journal.pone.0114369. eCollection 2014.

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

Zhilian Li  1 , Lu Cai  2 , Xinling Liang  3 , Zhiming Du  4 , Yuanhan Chen  1 , Shengli An  5 , Ning Tan  6 , Lixia Xu  1 , Ruizhao Li  1 , Liwen Li  6 , Wei Shi  1
Affiliations

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

Zhilian Li et al. PLoS One. .

Abstract

Objective: Acute 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.

Methods: The 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.

Results: Within 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).

Conclusion: KDIGO 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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Schematic of study sample with exclusions from analysis.
Figure 2
Figure 2. AKI distribution among RIFLE, AKIN and KDIGO classification.
Figure 3
Figure 3. In-hospital survival of CRS type 1 according to RIFLE(A), AKIN(B), KDIGO(C) and K(+)R(−)+K(+)A(−) definitions(D).
*: vs No-AKI, P<0.001;#:vs AKI by all three criteria, P = 0.061.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. McAlister FA, Ezekowitz J, Tonelli M, Armstrong PW (2004) Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation. 109:1004–1009. - PubMed
    1. Cowie MR, Komajda M, Murray-Thomas T, Underwood J, Ticho B, et al. (2006) Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J. 27:1216–1222. - PubMed
    1. Shirakabe A, Hata N, Kobayashi N, Shinada T, Tomita K, et al. (2012) Long-term prognostic impact after acute kidney injury in patients with acute heart failure. Int Heart J. 53:313–319. - PubMed
    1. Ronco C, Cicoira M, McCullough PA (2012) Cardiorenal syndrome type 1: pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol. 60:1031–1042. - PubMed
    1. Haase M, Müller C, Damman K, Murray PT, Kellum JA, et al. (2013) Pathogenesis of cardiorenal syndrome type 1 in acute decompensated heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol. 182:99–116. - PubMed

Publication types

LinkOut - more resources