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. 2018 Jun 25;19(1):149.
doi: 10.1186/s12882-018-0946-x.

The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: a validation study

Samuel H Howitt  1   2 , Stuart W Grant  3 , Camila Caiado  4 , Eric Carlson  5 , Dowan Kwon  3 , Ioannis Dimarakis  6 , Ignacio Malagon  3   7 , Charles McCollum  3
Affiliations

The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: a validation study

Samuel H Howitt et al. BMC Nephrol. .

Abstract

Background: The Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury (AKI) guidelines assign the same stage of AKI to patients whether they fulfil urine output criteria, serum creatinine criteria or both criteria for that stage. This study explores the validity of the KDIGO guidelines as a tool to stratify the risk of adverse outcomes in cardiac surgery patients.

Methods: Prospective data from consecutive adult patients admitted to the cardiac intensive care unit (CICU) following cardiac surgery between January 2013 and May 2015 were analysed. Patients were assigned to groups based on the criteria they met for each stage of AKI according to the KDIGO guidelines. Short and mid-term outcomes were compared between these groups.

Results: A total of 2267 patients were included with 772 meeting criteria for AKI-1 and 222 meeting criteria for AKI-2. After multivariable adjustment, patients meeting both urine output and creatinine criteria for AKI-1 were more likely to experience prolonged CICU stay (OR 4.9, 95%CI 3.3-7.4, p < 0.01) and more likely to require renal replacement therapy (OR 10.5, 95%CI 5.5-21.9, p < 0.01) than those meeting only the AKI-1 urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-1 were at an increased risk of mid-term mortality compared to those diagnosed with AKI-1 by urine output alone (HR 2.8, 95%CI 1.6-4.8, p < 0.01). Patients meeting both urine output and creatinine criteria for AKI-2 were more likely to experience prolonged CICU stay (OR 16.0, 95%CI 3.2-292.0, p < 0.01) or require RRT (OR 11.0, 95%CI 4.2-30.9, p < 0.01) than those meeting only the urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-2 were at a significantly increased risk of mid-term mortality compared to those diagnosed with AKI-2 by urine output alone (HR 3.6, 95%CI 1.4-9.3, p < 0.01).

Conclusions: Patients diagnosed with the same stage of AKI by different KDIGO criteria following cardiac surgery have significantly different short and mid-term outcomes. The KDIGO criteria need to be revisited before they can be used to stratify reliably the severity of AKI in cardiac surgery patients. The utility of the criteria also needs to be explored in other settings.

Keywords: Acute kidney injury; Cardiac surgery, Critical care.

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Conflict of interest statement

Ethics approval and consent to participate

All data were collected as part of the Vascular Governance North West (VGNW) database and processed according this project’s protocols and ethical approvals (National Research Ethics Service Haydock - 09/H1010/2 + 5). According to the National Research Ethics Committee approvals, verbal consent for participation was obtained. Inclusion of data recorded following verbal consent as well as historical data recorded prior to the date of ethical approval being granted were approved by same National Research Ethics Service committee as all data were recorded as part of routine care and anonymised prior to release to researchers.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart for inclusion of patients in analyses. RRT = renal replacement therapy, sCR = serum creatinine result, MCS = mechanical circulatory support, PLOS = prolonged length of stay
Fig. 2
Fig. 2
Kaplan Meier plots stratified according to the KDIGO criteria met for the maximum stage of AKI attained up to AKI-2. A separate group of patients who went straight to AKI-3 is shown for comparison. AKI – Acute Kidney Injury, UO – urine output, sCr – serum creatinine
See this image and copyright information in PMC

Comment in

References

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