A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury

Sean M. Bagshaw, Shigehiko Uchino, Dinna Cruz, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Etienne MacEdo, Noel Gibney, Ashita Tolwani, Heleen M. Oudemans-Van Straaten, Claudio Ronco, John A. Kellum

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

Background. The RIFLE classification scheme for acute kidney injury (AKI) is based on relative changes in serum creatinine (SCr) and on urine output. The SCr criteria, therefore, require a pre-morbid baseline value. When unknown, current recommendations are to estimate a baseline SCr by the MDRD equation. However, the MDRD approach assumes a glomerular filtration rate of ∼75 mLmin1.73 m2. This method has not been validated.Methods. Data from the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study, a prospective observational study from 54 ICUs in 23 countries of critically ill patients with severe AKI, were analysed. The RIFLE class was determined by using observed (o) pre-morbid and estimated (e) baseline SCr values. Agreement was evaluated by correlation coefficients and Bland-Altman plots. Sensitivity analysis by chronic kidney disease (CKD) status was performed.Results. Seventy-six percent of patients (n = 1327) had a pre-morbid baseline SCr, and 1314 had complete data for evaluation. Forty-six percent had CKD. The median (IQR) values were 97 μmolL (79-150) for oSCr and 88 μmolL (71-97) for eSCr. The oSCr and eSCr determined at ICU admission and at study enrolment showed only a modest correlation (r = 0.49, r = 0.39). At ICU admission and study enrolment, eSCr misclassified 18.8 and 11.7 of patients as having AKI compared with oSCr. Exclusion of CKD patients improved the correlation between oSCr and eSCr at ICU admission and study enrolment (r = 0.90, r = 0.84) resulting in 6.6 and 4.0 being misclassified, respectively.Conclusions. While limited, estimating baseline SCr by the MDRD equation when pre-morbid SCr is unavailable would appear to perform reasonably well for determining the RIFLE categories only if and when pre-morbid GFR was near normal. However, in patients with suspected CKD, the use of MDRD to estimate baseline SCr overestimates the incidence of AKI and should not likely be used. Improved methods to estimate baseline SCr are needed.

Original languageEnglish
Pages (from-to)2739-2744
Number of pages6
JournalNephrology Dialysis Transplantation
Volume24
Issue number9
DOIs
Publication statusPublished - Sep 2009

Fingerprint

Acute Kidney Injury
Creatinine
Serum
Chronic Renal Insufficiency
Glomerular Filtration Rate
Critical Illness
Observational Studies
Urine
Prospective Studies
Kidney
Incidence

Keywords

  • Acute kidney injury
  • Consensus definition
  • Creatinine
  • RIFLE criteria
  • Validation

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury. / Bagshaw, Sean M.; Uchino, Shigehiko; Cruz, Dinna; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; MacEdo, Etienne; Gibney, Noel; Tolwani, Ashita; Oudemans-Van Straaten, Heleen M.; Ronco, Claudio; Kellum, John A.

In: Nephrology Dialysis Transplantation, Vol. 24, No. 9, 09.2009, p. 2739-2744.

Research output: Contribution to journalArticle

Bagshaw, SM, Uchino, S, Cruz, D, Bellomo, R, Morimatsu, H, Morgera, S, Schetz, M, Tan, I, Bouman, C, MacEdo, E, Gibney, N, Tolwani, A, Oudemans-Van Straaten, HM, Ronco, C & Kellum, JA 2009, 'A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury', Nephrology Dialysis Transplantation, vol. 24, no. 9, pp. 2739-2744. https://doi.org/10.1093/ndt/gfp159
Bagshaw, Sean M. ; Uchino, Shigehiko ; Cruz, Dinna ; Bellomo, Rinaldo ; Morimatsu, Hiroshi ; Morgera, Stanislao ; Schetz, Miet ; Tan, Ian ; Bouman, Catherine ; MacEdo, Etienne ; Gibney, Noel ; Tolwani, Ashita ; Oudemans-Van Straaten, Heleen M. ; Ronco, Claudio ; Kellum, John A. / A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury. In: Nephrology Dialysis Transplantation. 2009 ; Vol. 24, No. 9. pp. 2739-2744.
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abstract = "Background. The RIFLE classification scheme for acute kidney injury (AKI) is based on relative changes in serum creatinine (SCr) and on urine output. The SCr criteria, therefore, require a pre-morbid baseline value. When unknown, current recommendations are to estimate a baseline SCr by the MDRD equation. However, the MDRD approach assumes a glomerular filtration rate of ∼75 mLmin1.73 m2. This method has not been validated.Methods. Data from the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study, a prospective observational study from 54 ICUs in 23 countries of critically ill patients with severe AKI, were analysed. The RIFLE class was determined by using observed (o) pre-morbid and estimated (e) baseline SCr values. Agreement was evaluated by correlation coefficients and Bland-Altman plots. Sensitivity analysis by chronic kidney disease (CKD) status was performed.Results. Seventy-six percent of patients (n = 1327) had a pre-morbid baseline SCr, and 1314 had complete data for evaluation. Forty-six percent had CKD. The median (IQR) values were 97 μmolL (79-150) for oSCr and 88 μmolL (71-97) for eSCr. The oSCr and eSCr determined at ICU admission and at study enrolment showed only a modest correlation (r = 0.49, r = 0.39). At ICU admission and study enrolment, eSCr misclassified 18.8 and 11.7 of patients as having AKI compared with oSCr. Exclusion of CKD patients improved the correlation between oSCr and eSCr at ICU admission and study enrolment (r = 0.90, r = 0.84) resulting in 6.6 and 4.0 being misclassified, respectively.Conclusions. While limited, estimating baseline SCr by the MDRD equation when pre-morbid SCr is unavailable would appear to perform reasonably well for determining the RIFLE categories only if and when pre-morbid GFR was near normal. However, in patients with suspected CKD, the use of MDRD to estimate baseline SCr overestimates the incidence of AKI and should not likely be used. Improved methods to estimate baseline SCr are needed.",
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T1 - A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury

AU - Bagshaw, Sean M.

AU - Uchino, Shigehiko

AU - Cruz, Dinna

AU - Bellomo, Rinaldo

AU - Morimatsu, Hiroshi

AU - Morgera, Stanislao

AU - Schetz, Miet

AU - Tan, Ian

AU - Bouman, Catherine

AU - MacEdo, Etienne

AU - Gibney, Noel

AU - Tolwani, Ashita

AU - Oudemans-Van Straaten, Heleen M.

AU - Ronco, Claudio

AU - Kellum, John A.

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N2 - Background. The RIFLE classification scheme for acute kidney injury (AKI) is based on relative changes in serum creatinine (SCr) and on urine output. The SCr criteria, therefore, require a pre-morbid baseline value. When unknown, current recommendations are to estimate a baseline SCr by the MDRD equation. However, the MDRD approach assumes a glomerular filtration rate of ∼75 mLmin1.73 m2. This method has not been validated.Methods. Data from the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study, a prospective observational study from 54 ICUs in 23 countries of critically ill patients with severe AKI, were analysed. The RIFLE class was determined by using observed (o) pre-morbid and estimated (e) baseline SCr values. Agreement was evaluated by correlation coefficients and Bland-Altman plots. Sensitivity analysis by chronic kidney disease (CKD) status was performed.Results. Seventy-six percent of patients (n = 1327) had a pre-morbid baseline SCr, and 1314 had complete data for evaluation. Forty-six percent had CKD. The median (IQR) values were 97 μmolL (79-150) for oSCr and 88 μmolL (71-97) for eSCr. The oSCr and eSCr determined at ICU admission and at study enrolment showed only a modest correlation (r = 0.49, r = 0.39). At ICU admission and study enrolment, eSCr misclassified 18.8 and 11.7 of patients as having AKI compared with oSCr. Exclusion of CKD patients improved the correlation between oSCr and eSCr at ICU admission and study enrolment (r = 0.90, r = 0.84) resulting in 6.6 and 4.0 being misclassified, respectively.Conclusions. While limited, estimating baseline SCr by the MDRD equation when pre-morbid SCr is unavailable would appear to perform reasonably well for determining the RIFLE categories only if and when pre-morbid GFR was near normal. However, in patients with suspected CKD, the use of MDRD to estimate baseline SCr overestimates the incidence of AKI and should not likely be used. Improved methods to estimate baseline SCr are needed.

AB - Background. The RIFLE classification scheme for acute kidney injury (AKI) is based on relative changes in serum creatinine (SCr) and on urine output. The SCr criteria, therefore, require a pre-morbid baseline value. When unknown, current recommendations are to estimate a baseline SCr by the MDRD equation. However, the MDRD approach assumes a glomerular filtration rate of ∼75 mLmin1.73 m2. This method has not been validated.Methods. Data from the Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study, a prospective observational study from 54 ICUs in 23 countries of critically ill patients with severe AKI, were analysed. The RIFLE class was determined by using observed (o) pre-morbid and estimated (e) baseline SCr values. Agreement was evaluated by correlation coefficients and Bland-Altman plots. Sensitivity analysis by chronic kidney disease (CKD) status was performed.Results. Seventy-six percent of patients (n = 1327) had a pre-morbid baseline SCr, and 1314 had complete data for evaluation. Forty-six percent had CKD. The median (IQR) values were 97 μmolL (79-150) for oSCr and 88 μmolL (71-97) for eSCr. The oSCr and eSCr determined at ICU admission and at study enrolment showed only a modest correlation (r = 0.49, r = 0.39). At ICU admission and study enrolment, eSCr misclassified 18.8 and 11.7 of patients as having AKI compared with oSCr. Exclusion of CKD patients improved the correlation between oSCr and eSCr at ICU admission and study enrolment (r = 0.90, r = 0.84) resulting in 6.6 and 4.0 being misclassified, respectively.Conclusions. While limited, estimating baseline SCr by the MDRD equation when pre-morbid SCr is unavailable would appear to perform reasonably well for determining the RIFLE categories only if and when pre-morbid GFR was near normal. However, in patients with suspected CKD, the use of MDRD to estimate baseline SCr overestimates the incidence of AKI and should not likely be used. Improved methods to estimate baseline SCr are needed.

KW - Acute kidney injury

KW - Consensus definition

KW - Creatinine

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