Postoperative Acute Kidney Injury among Patients with Chronic Kidney Disease: Comparisons between the AKIN and KDIGO Creatinine Criteria in Diagnosis and Prognosis

摘要

OBJECTIVES: This retrospective study determines whether the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria are superior to Acute Kidney Injury Network (AKIN) creatinine criteria in detecting non-dialysis Acute Kidney Injury (AKI) events and predicting mortality in chronic kidney disease (CKD) patients after surgery. METHODS: Surgical patients who were admitted to the intensive care unit were enrolled. Non-dialysis AKI cases were defined using either KDIGO or AKIN creatinine criteria and stratified by CKD stages. The adjusted hazard ratios (AHRs) for in-hospital mortality are compared to those without AKI. The cumulative survival curves and the predictability for mortality are accessed by Kaplan-Meier method and calculating the area under the curve (AUC) for the receiver operating characteristic curve (ROC), respectively. RESULTS: From a total of 771 postoperative patients, the overall in-hospital mortality rate was 16.2% (125 cases) and that for AKI according to KDIGO and AKIN creatinine criteria was 23.5% (181 cases) and 22.7% (175 cases), respectively. The cumulative survival curve stratified by CKD and AKI stages were comparable between KDIGO and AKIN creatinine criteria. The discriminative power for mortality stratified by CKD stages for KDIGO and AKIN creatinine criteria are as followed: all subjects, 0.673 vs. 0.658; non CKD, 0.866 vs. 0.822; early stage CKD: 0.725 vs. 0.711; late stage CKD: 0.645 vs. 0.629 (all Ps < 0.001, except in late stage CKD (P = 0.013 vs. 0.030)). CONCLUSION: The KDIGO creatinine criteria is superior to AKIN creatinine criteria in predicting mortality and detecting non-dialysis AKI events after surgery, even in those with advanced CKD.