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Abstract: TH-PO066

A Modified Renal Angina Index by Using the Kinetic Glomerular Filtration Rate for Predicting AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Claure-Del Granado, Rolando, Hospital Obrero #2 - C.N.S.; Universidad Mayor de San Simon, School of Medicine, Cochabamba, Cercado, Bolivia, Plurinational State of
  • Silva-Rojas, Adriana V., Hospital Obrero #2 - C.N.S., Cochabamba, Bolivia, Plurinational State of
  • Valencia-Coronel, Brandon, Hospital Obrero #2 - C.N.S., Cochabamba, Bolivia, Plurinational State of
Background

Reliable prediction of AKI has the potential to optimize its treatment. Recently Goldstein SL et al. proposed an empiric clinical model of renal angina to identify critically ill children who would be at higher risk of AKI. In children the combination of the renal angina index (RAI) and AKI biomarkers has an excellent diagnostic performance. The purpose of this study was to evaluate the performance of a modified RAI using kinetic glomerular filtration rate (KeGFR) for the prediction of AKI in a cohort of critically ill adults.

Methods

We included 208 consecutive patients admitted to our medical ICU. Serum creatinine (sCr) was measure every 24 hours for 7 consecutive days following ICU admission. RAI was calculated 24 hours after ICU admission (day 1) using the following formula: Risk level (presence of sepsis, use of vasopressors and/or use of invasive mechanical ventilation, and presence of diabetes mellitus) x Injury level (changes in kidney function based on KeGFR). KeGFR was calculated from the change in consecutive values of sCr using the formula developed by Chen S. We used KDIGO AKI sCr criteria to diagnose AKI. In patients with no baseline sCr available we back calculated baseline sCr using MDRD equation (for an eGFR = 75 ml/m/1.73m2). We analyzed if a modified RAI score ≥6 points could predict subsequent AKI (after 48 hours).

Results

From 208 patients enrolled in the study 101 patients developed AKI (48.6 %). Age, baseline sCr, and eGFR (CKD-EPI) we not different between patients with AKI and patients without AKI. At 24 hours post ICU admission patients with AKI had lower KeGFR (47.7 ml/m vs. 81.1 ml/m; p < 0.0001). A renal angina index ≥6 points was able to identify individuals who developed AKI after 48 hours of ICU admission, with a ROC-AUC of 0.697 (95% CI 0.626-0.769), p < 0.0001. A Renal Angina Index of ≥6 points had an OR of 9.9 (95% CI 2.65 – 37.11; p < 0.0001) for subsequent development of AKI after 48 hours of ICU admission.

Conclusion

A modified renal angina index by using the KeGFR provides a clinically feasible methodology to identify critically ill adults at high risk of developing AKI before a rise in serum creatinine occurs. This tool would permit the early identification of AKI to initiate preventive and treatment strategies minimizing extension of kidney injury.