The KDIGO acute kidney injury guidelines for cardiac surgery ...

The Kidney Disease: Improving Global Outcomes (KDIGO) AKI guidelines were designed to standardise the criteria for AKI based on serum creatinine ... Skiptomaincontent Advertisement SearchallBMCarticles Search TheKDIGOacutekidneyinjuryguidelinesforcardiacsurgerypatientsincriticalcare:avalidationstudy DownloadPDF DownloadPDF Researcharticle OpenAccess Published:25June2018 TheKDIGOacutekidneyinjuryguidelinesforcardiacsurgerypatientsincriticalcare:avalidationstudy SamuelH.Howitt  ORCID:orcid.org/0000-0002-8338-97651,2,StuartW.Grant1,CamilaCaiado3,EricCarlson4,DowanKwon1,IoannisDimarakis5,IgnacioMalagon1,2&…CharlesMcCollum1 Showauthors BMCNephrology volume 19,Article number: 149(2018) Citethisarticle 3505Accesses 28Citations 8Altmetric Metricsdetails AbstractBackgroundTheKidneyDisease:ImprovingGlobalOutcomes(KDIGO)AcuteKidneyInjury(AKI)guidelinesassignthesamestageofAKItopatientswhethertheyfulfilurineoutputcriteria,serumcreatininecriteriaorbothcriteriaforthatstage.ThisstudyexploresthevalidityoftheKDIGOguidelinesasatooltostratifytheriskofadverseoutcomesincardiacsurgerypatients.MethodsProspectivedatafromconsecutiveadultpatientsadmittedtothecardiacintensivecareunit(CICU)followingcardiacsurgerybetweenJanuary2013andMay2015wereanalysed.PatientswereassignedtogroupsbasedonthecriteriatheymetforeachstageofAKIaccordingtotheKDIGOguidelines.Shortandmid-termoutcomeswerecomparedbetweenthesegroups.ResultsAtotalof2267patientswereincludedwith772meetingcriteriaforAKI-1and222meetingcriteriaforAKI-2.Aftermultivariableadjustment,patientsmeetingbothurineoutputandcreatininecriteriaforAKI-1weremorelikelytoexperienceprolongedCICUstay(OR4.9,95%CI3.3–7.4,p  72 hforallotherpatients.StatisticalanalysesPatientswereassignedtogroupsbasedonthestagesofAKItheyreachedaccordingtotheKDIGOguidelines.WithinthegroupsthatreachedeachAKIstage,patientswerecategorisedaseitheri)meetingtheurineoutputcriteriaii)meetingtheserumcreatininecriteriaoriii)meetingbothurineoutputandserumcreatininecriteria.RatesofprolongedLOS,RRTand2-yearmortalityforthosewhodidnotdevelopAKIwerecomparedwiththoseforpatientsdiagnosedwithAKI-1byurineoutputalone.AnalyseswithingroupsofpatientsmeetingdifferentcombinationsofcriteriaforeachstageofAKIwerethenperformed.ThenullhypothesiswasthatoutcomeswouldbesimilarbetweenpatientsdiagnosedwiththesamestageofAKIbasedonthedifferentKDIGOcriteria.Univariableanalysesofcategoricaloutcomeswereperformedusingthechi-squaretestorFisher’sexacttestintheeventofsparsedata.ThelogisticEuroSCORE[16]whichcalculatesmortalityriskforcardiacsurgerybasedon13preoperativevariables(includingpreoperativerenalfunction)andfouroperativevariableswasusedtoadjustforsurgicalriskinmultivariablelogisticregressionmodels.ThelogisticEuroSCOREhasbeenshowntohaveadequatediscriminatoryabilityinUKcardiacsurgery[17].TheresultsofthemultivariableanalysesaredetailedintheAdditional file 1.Univariableandmultivariableanalysesofmid-termmortalityrateswereperformedusingthelog-ranktestandCoxproportionalhazardsregressionmodellingrespectively.DatacleaningandstatisticalanalyseswereconductedusingR(RFoundationforstatisticalcomputing)[18].ResultsDatafrom2284patientswereavailable.SevenpatientswhorequiredRRTpreoperativelyandtenpatientswithnopreoperativecreatininevalueswereexcludedleaving2267patientsfortheanalysis(Fig.1).PatientcharacteristicsareshowninTable 2.Therewere1448patientswhodidnotdevelopAKIduringtheirCICUstay.Atotalof819(36.1%)developedAKIand147(6.5%)requiredRRT.Therewere177(7.8%)patientswhodiedwithintwoyearsofsurgery.Ofthe1448patientswhodidnotdevelopAKI,255(17.7%)hadaprolongedLOSonCICUandthe2-yearmortalityrateforthisgroupwas3.9%.Table2CharacteristicsofpatientsadmittedtothecardiacintensivecareunitfollowingcardiacsurgeryFullsizetableAcutekidneyinjurystage1(urineoutputonly)vsnoAKIAKI-1wasdiagnosedin772(34.1%)patients(Table 3)with370(47.9%)ofthesepatientsmeetingonlytheurineoutputcriterion(AKI-1-UO).AsAKI-1-UOpatientshadthebestoutcomes(amongpatientswhodevelopedAKI) thesepatientswerecomparedwiththenoAKIgroup.Onunivariableanalysis,therateofprolongedLOSforAKI-1-UO(39.6%)wassignificantlyhigherthanforpatientswithoutAKI(p