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
. 2021 Sep-Oct;71(5):511-516.
doi: 10.1016/j.bjane.2021.02.016. Epub 2021 Feb 10.

Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria

Tiago Furquim da Silva  1 , Kelly Regina da Cruz Silva  2 , Crissiane Melo Nepomuceno  2 , Cora Salles Maruri Corrêa  2 , João Pedro Mello Godoy  2 , Ari Tadeu Lírio Dos Santos  3 , Alessandra Sarturi Gheller  3
Affiliations

Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria

Tiago Furquim da Silva et al. Braz J Anesthesiol. 2021 Sep-Oct.

Abstract

Background and objectives: Data on urine output have not been routinely presented to define cardiac surgery-related acute kidney injury (AKI). We evaluated the incidence of AKI after cardiac surgery based on the AKIN and KDIGO criteria (considering serum creatinine concentration and urine output in the first 72 hours postoperatively) and compared the performance of the 2 criteria for AKI staging.

Methods: This was a prospective cohort study of adult patients undergoing coronary artery bypass grafting (CABG), valve replacement, or CABG + valve replacement between October 2017 and April 2018 at a single institution. Patients were excluded if baseline creatinine concentration (measured within 7 days before surgery) was ≥ 2.5 mg.dL-1. Patients were evaluated for the development of AKI based on changes in urine output and serum creatinine concentration, measured daily from postoperative day 1 to 7, according to the AKIN and KDIGO criteria, which were then compared.

Results: A total of 198 patients were included. AKI occurred in 83.8% by AKIN and in 82.8% by KDIGO, when using both urine output and serum creatinine concentration as defining criteria. Using serum creatinine concentration alone, the incidence of AKI fell to 27.3% by AKIN and to 24.7% by KDIGO. A kappa coefficient of 0.98 was obtained between the AKIN and KDIGO criteria.

Conclusions: Almost perfect agreement was found between AKIN and KDIGO. AKI may be underdiagnosed after cardiac surgery if serum creatinine concentration is used as the only defining criterion. Our findings underscore the fundamental importance of using the urine output criterion in the assessment of patients at risk for AKI.

Keywords: Acute kidney injury; Cardiac surgery; Intensive care; Postoperative care; Serum creatinine; Urine output.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Incidence of AKI per postoperative day. AKI, acute kidney injury.
See this image and copyright information in PMC

References

    1. Olivero J.J., Nguyen P.T., Kagan A. Acute kidney injury after cardiovascular surgery: an overview. Methodist Debakey Cardiovasc J. 2012;8:31–36. - PMC - PubMed
    1. Mizuguchi K.A., Huang C.C., Shempp I., et al. Predicting kidney disease progression in patients with acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg. 2018;155:2455–2463. e5. - PubMed
    1. Grynberg K., Polkinghorne K.R., Ford S., et al. Early serum creatinine accurately predicts acute kidney injury post cardiac surgery. BMC Nephrol. 2017;18:93. - PMC - PubMed
    1. Mariscalco G., Lorusso R., Dominici C., et al. Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg. 2011;92:1539–1547. - PubMed
    1. Thakar C.V., Arrigain S., Worley S., et al. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16:162–168. - PubMed