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Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients

INTRODUCTION: Serum creatinine concentration (sCr) is the marker used for diagnosing and staging acute kidney injury (AKI) in the RIFLE and AKIN classification systems, but is influenced by several factors including its volume of distribution. We evaluated the effect of fluid accumulation on sCr to...

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Autores principales: Macedo, Etienne, Bouchard, Josée, Soroko, Sharon H, Chertow, Glenn M, Himmelfarb, Jonathan, Ikizler, T Alp, Paganini, Emil P, Mehta, Ravindra L
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911707/
https://www.ncbi.nlm.nih.gov/pubmed/20459609
http://dx.doi.org/10.1186/cc9004
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author Macedo, Etienne
Bouchard, Josée
Soroko, Sharon H
Chertow, Glenn M
Himmelfarb, Jonathan
Ikizler, T Alp
Paganini, Emil P
Mehta, Ravindra L
author_facet Macedo, Etienne
Bouchard, Josée
Soroko, Sharon H
Chertow, Glenn M
Himmelfarb, Jonathan
Ikizler, T Alp
Paganini, Emil P
Mehta, Ravindra L
author_sort Macedo, Etienne
collection PubMed
description INTRODUCTION: Serum creatinine concentration (sCr) is the marker used for diagnosing and staging acute kidney injury (AKI) in the RIFLE and AKIN classification systems, but is influenced by several factors including its volume of distribution. We evaluated the effect of fluid accumulation on sCr to estimate severity of AKI. METHODS: In 253 patients recruited from a prospective observational study of critically-ill patients with AKI, we calculated cumulative fluid balance and computed a fluid-adjusted sCr concentration reflecting the effect of volume of distribution during the development phase of AKI. The time to reach a relative 50% increase from the reference sCr using the crude and adjusted sCr was compared. We defined late recognition to estimate severity of AKI when this time interval to reach 50% relative increase between the crude and adjusted sCr exceeded 24 hours. RESULTS: The median cumulative fluid balance increased from 2.7 liters on day 2 to 6.5 liters on day 7. The difference between adjusted and crude sCr was significantly higher at each time point and progressively increased from a median difference of 0.09 mg/dL to 0.65 mg/dL after six days. Sixty-four (25%) patients met criteria for a late recognition to estimate severity progression of AKI. This group of patients had a lower urine output and a higher daily and cumulative fluid balance during the development phase of AKI. They were more likely to need dialysis but showed no difference in mortality compared to patients who did not meet the criteria for late recognition of severity progression. CONCLUSIONS: In critically-ill patients, the dilution of sCr by fluid accumulation may lead to underestimation of the severity of AKI and increases the time required to identify a 50% relative increase in sCr. A simple formula to correct sCr for fluid balance can improve staging of AKI and provide a better parameter for earlier recognition of severity progression.
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spelling pubmed-29117072010-07-29 Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients Macedo, Etienne Bouchard, Josée Soroko, Sharon H Chertow, Glenn M Himmelfarb, Jonathan Ikizler, T Alp Paganini, Emil P Mehta, Ravindra L Crit Care Research INTRODUCTION: Serum creatinine concentration (sCr) is the marker used for diagnosing and staging acute kidney injury (AKI) in the RIFLE and AKIN classification systems, but is influenced by several factors including its volume of distribution. We evaluated the effect of fluid accumulation on sCr to estimate severity of AKI. METHODS: In 253 patients recruited from a prospective observational study of critically-ill patients with AKI, we calculated cumulative fluid balance and computed a fluid-adjusted sCr concentration reflecting the effect of volume of distribution during the development phase of AKI. The time to reach a relative 50% increase from the reference sCr using the crude and adjusted sCr was compared. We defined late recognition to estimate severity of AKI when this time interval to reach 50% relative increase between the crude and adjusted sCr exceeded 24 hours. RESULTS: The median cumulative fluid balance increased from 2.7 liters on day 2 to 6.5 liters on day 7. The difference between adjusted and crude sCr was significantly higher at each time point and progressively increased from a median difference of 0.09 mg/dL to 0.65 mg/dL after six days. Sixty-four (25%) patients met criteria for a late recognition to estimate severity progression of AKI. This group of patients had a lower urine output and a higher daily and cumulative fluid balance during the development phase of AKI. They were more likely to need dialysis but showed no difference in mortality compared to patients who did not meet the criteria for late recognition of severity progression. CONCLUSIONS: In critically-ill patients, the dilution of sCr by fluid accumulation may lead to underestimation of the severity of AKI and increases the time required to identify a 50% relative increase in sCr. A simple formula to correct sCr for fluid balance can improve staging of AKI and provide a better parameter for earlier recognition of severity progression. BioMed Central 2010 2010-05-06 /pmc/articles/PMC2911707/ /pubmed/20459609 http://dx.doi.org/10.1186/cc9004 Text en Copyright ©2010 Macedo et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Macedo, Etienne
Bouchard, Josée
Soroko, Sharon H
Chertow, Glenn M
Himmelfarb, Jonathan
Ikizler, T Alp
Paganini, Emil P
Mehta, Ravindra L
Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients
title Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients
title_full Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients
title_fullStr Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients
title_full_unstemmed Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients
title_short Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients
title_sort fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911707/
https://www.ncbi.nlm.nih.gov/pubmed/20459609
http://dx.doi.org/10.1186/cc9004
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