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Kidney Week

Abstract: TH-PO041

Comparison Between Creatinine vs Urinary Output Criteria in RIFLE and KDIGO Definitions for AKI Post Major Elective Non-Vascular Abdominal Surgeries

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • de Souza, Graziela Ramos barbosa de, São Paulo University , São Paulo, Brazil
  • Marçal, Lia Junqueira, University of São Paulo, S Paulo, Brazil
  • Yu, Luis, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
  • Antonangelo, Leila, University of São Paulo, S Paulo, Brazil
  • Zanetta, Dirce M T, University of São Paulo, S Paulo, Brazil
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
Background

Most of the studies using RIFLE and KDIGO AKI definitions are solely based on serum creatinine (SCr) changes. However, the urinary output (UO) criteria may be more sensitive especially for surgical patients. Therefore, the aim of this study was to compare the efficacy of SCr and UO criteria for RIFLE and KDIGO AKI diagnosis and outcome of patients (pts) submitted to major elective non vascular abdominal surgeries (MENVAS) admitted to the ICU.

Methods

Two hundred and twenty five pts were prospectively evaluated, peri-operatively, from the ICU admission until 7 days of hospitalization. Serum creatinine (mg/dl) was measured before surgery and once a day until day 7 or ICU discharge. Hourly UO (ml/kg/h) was measured daily. AKI was diagnosed using either SCr or UO according to RIFLE and KDIGO definitions. Data are presented as mean ± SD or frequencies. Statistical significance was set at p<0.05.

Results

A total of 225 pts were analysed, 126 (56%) developed AKI. Most frequent types of surgery were: hepatectomy, sleeve gastroplasty, gastrectomy, hepatectomy + cholecystectomy, gastroduodenopancreatectomy and, adrenalectomy. AKI pts were older 57.6 ± 1.2 vs. 50.8 ± 1.6 Non -AKI (p = 0.0007). Duration (min) of surgery in AKI pts was 365.6 ± 18.3 vs. 341.5 ± 16.8 Non-AKI (NS). The AKI diagnoses according to RIFLE were: 118 by UO and 38 by SCr criteria. According to KDIGO definition: 118 by UO and 39 by SCr criteria. In addition, 31 pts fullfilled both criteria simultaneously.
Using the SCr criteria alone for AKI diagnosis, a total of 87 patients in RIFLE group and KDIGO group would be overlooked while only one additional patient was diagnosed by KDIGO. AKI pts (KDIGO definition) diagnosed by UO or SCr criteria changes, presented, compared to Non-AKI pts: hospital LoS 21.4 ± 1.9 vs. 25.6 ± 3.8 (p <0.0004), ICU LoS 3.6 ± 0.3 vs 5.8 ± 0.97 (p < 0.0001). Mortality in the AKI group was 10.2% vs. 2.0 % in Non-AKI (p=0.0149).

Conclusion

Utilization of SCr criteria instead of UO for RIFLE and KDIGO definitions in surgical patients would overlook a very high number of AKI patients (69%). Urinary output criteria seems to be pivotal for early AKI recognition in these patients. Furthermore, AKI post MENVAS is frequent and carries worse outcome and mortality.

Funding

  • Government Support - Non-U.S.