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

Silva, Tiago Furquim da; Silva, Kelly Regina da Cruz; Nepomuceno, Crissiane Melo; Corrêa, Cora Salles Maruri; Godoy, João Pedro Mello; Santos, Ari Tadeu Lírio dos; Gheller, Alessandra Sarturi

doi:10.1016/j.bjane.2021.02.016

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Brazilian Journal of Anesthesiology

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Sumário

Clinical Research • para Braz. J. Anesthesiol. 71 (5) • Sep-Oct 2021 • https://doi.org/10.1016/j.bjane.2021.02.016 copy

Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria^☆ ☆ Study conducted at Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

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; Serum creatinine; Urine output; Intensive care; Postoperative care

Stage	AKIN Criterion		KDIGO Criterion
Stage	Serum creatinine	Urine output	Serum creatinine	Urine output
1	Increase in serum creatinine of 1.5 to 2 times baseline level or increase in serum creatinine of ≥ 0.3 mg.dL^-1 within 48 hours.	Urine output < 0.5 mL.kg^-1.h^-1 for > 6 hours.	Increase in serum creatinine of 1.5 to 1.9 times baseline level within 7 days or increase in serum creatinine of ≥ 0.3 mg.dL^-1.	Urine output < 0.5 mL.kg^-1.h^-1 for > 6 hours.
2	Increase in serum creatinine of > 2 to 3 times baseline level within 48 hours.	Urine output < 0.5 mL.kg^-1.h^-1 for > 12 hours.	Increase in serum creatinine of 2 to 2.9 times baseline level within 7 days.	Urine output < 0.5 mL.kg^-1.h^-1 for > 12 hours.
3	Increase in serum creatinine of > 3 times baseline level within 48 hours or increase in serum creatinine to ≥ 4.0 mg.dL^-1 or initiation of RRT.	Urine output < 0.3 mL.kg^-1.h^-1 for ≥ 24 hours or anuria for ≥ 12 hours.	Increase in serum creatinine of ≥ 3 times baseline level within 7 days or increase in serum creatinine to ≥ 4.0 mg.dL^-1 or initiation of RRT.	Urine output < 0.3 mL.kg^-1.h^-1 for ≥ 24 hours or anuria for ≥ 12 hours.

Characteristic	n (%) or mean ± SD
Age (years), mean ± SD	61.11 (12.62)
Female, n (%)	85 (42.9)
Weight (kg), mean ± SD	75.5 ± 14.7
Baseline creatinine (mg.dL^-1), mean ± SD	0.98 ± 0.30
Type of surgery, n (%)
CABG	96 (48.5)
Valve replacement	90 (45.5)
CABG + valve replacement	12 (6.1)

	Stage	KDIGO				Total AKIN (n)
	Stage	No AKI	1	2	3	Total AKIN (n)
AKIN	No AKI	144	0	0	0	144
	1	5	42	1	0	48
	2	0	1	1	0	2
	3	0	0	1	3	4
	Total KDIGO (n)	149	43	3	3	198
Kappa coefficient = 0.89 (p < 0.001)

	Stage	KDIGO				Total AKIN (n)
	Stage	No AKI	1	2	3	Total AKIN (n)
AKIN	No AKI	32	0	0	0	32
	1	2	46	0	0	48
	2	0	0	101	0	101
	3	0	0	0	17	17
	Total KDIGO (n)	34	46	101	17	198
Kappa coefficient = 0.98 (p < 0.001)

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. drtiagofurquim@gmail.com tiagofurquim@me.com

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Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria☆ ☆ Study conducted at Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, RS, Brazil.

Abstract

Background and objectives

Methods

Results

Conclusions

Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria^☆ ☆ Study conducted at Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, RS, Brazil.