AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria

Clinical Interventions in Aging, Jun 2018

AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria Qinglin Li,1 Meng Zhao,2 Xiaodan Wang1 1Department of Health Care, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China; 2Department of Clinical Data Repository, Chinese PLA General Hospital, Beijing, China Objectives: To compare the differences between the Kidney Disease Improving Global Outcomes (KDIGO) criteria of the 48-hour window and the 7-day window in the diagnosis of acute kidney injury (AKI) in very elderly patients, as well as the relationship between the 48-hour and 7-day windows for diagnosis and 90-day mortality. Patients and methods: We retrospectively enrolled very elderly patients (≥75 years old) from the geriatrics department of the Chinese PLA General Hospital between January 2007 and December 2015. AKI patients were divided into 48-hour and 7-day groups by their diagnosis criteria. AKI patients were divided into survivor and nonsurvivor groups by their outcomes within 90 days after diagnosis of AKI. Results: In total, 652 patients were included in the final analysis. The median age of the cohort was 87 (84–91) years, the majority (623, 95.6%) of whom were male. Of the 652 AKI patients, 334 cases (51.2%) were diagnosed with AKI by the 48-hour window for diagnosis, while 318 cases (48.8%) were by the 7-day window for diagnosis. The 90-day mortality was 42.5% in patients with 48-hour window AKI and 24.2% in patients with 7-day window AKI. Kaplan–Meier curves showed that 90-day mortality was lower in the 7-day window AKI group than in the 48-hour window AKI group (log rank: P<0.001). Multivariate analysis by the Cox model revealed that 48-hour window for diagnosis hazard ratio (HR=1.818; 95% CI: 1.256–2.631; P=0.002) was associated with higher 90-day mortality. Conclusion: The 90-day mortality was higher in 48-hour window AKI than in 7-day window AKI in very elderly patients. The 48-hour KDIGO window definition may be less sensitive. The 48-hour KDIGO window definition is significantly better correlated with subsequent mortality and is, therefore, still appropriate for clinical use. Finding early, sensitive biomarkers of kidney damage is a future direction of research. Keywords: acute kidney injury, AKI diagnosis time, very elderly, short-term mortality

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AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria

Clinical Interventions in Aging AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIgO criteria Qinglin li 1 Meng Zhao 0 Xiaodan Wang 1 0 Department of Clinical Data r epository, Chinese Pl A g eneral hospital , Beijing , China 1 Department of health Care, n anlou Division, Chinese Pl A g eneral hospital, n ational Clinical research Center for geriatric Diseases , Beijing , China PowerdbyTCPDF(ww.tcpdf.org) Objectives: To compare the differences between the Kidney Disease Improving Global Outcomes (KDIGO) criteria of the 48-hour window and the 7-day window in the diagnosis of acute kidney injury (AKI) in very elderly patients, as well as the relationship between the 48-hour and 7-day windows for diagnosis and 90-day mortality. Patients and methods: We retrospectively enrolled very elderly patients ($75 years old) from the geriatrics department of the Chinese PLA General Hospital between January 2007 and December 2015. AKI patients were divided into 48-hour and 7-day groups by their diagnosis criteria. AKI patients were divided into survivor and nonsurvivor groups by their outcomes within 90 days after diagnosis of AKI. Results: In total, 652 patients were included in the final analysis. The median age of the cohort was 87 (84-91) years, the majority (623, 95.6%) of whom were male. Of the 652 AKI patients, 334 cases (51.2%) were diagnosed with AKI by the 48-hour window for diagnosis, while 318 cases (48.8%) were by the 7-day window for diagnosis. The 90-day mortality was 42.5% in patients with 48-hour window AKI and 24.2% in patients with 7-day window AKI. KaplanMeier curves showed that 90-day mortality was lower in the 7-day window AKI group than in the 48-hour window AKI group (log rank: P,0.001). Multivariate analysis by the Cox model revealed that 48-hour window for diagnosis hazard ratio (HR=1.818; 95% CI: 1.256-2.631; P=0.002) was associated with higher 90-day mortality. Conclusion: The 90-day mortality was higher in 48-hour window AKI than in 7-day window AKI in very elderly patients. The 48-hour KDIGO window definition may be less sensitive. The 48-hour KDIGO window definition is significantly better correlated with subsequent mortality and is, therefore, still appropriate for clinical use. Finding early, sensitive biomarkers of kidney damage is a future direction of research. - 8 1 0 2 l u J 2 1 n o 1 2 2 . 8 9 . 2 3 . 3 1 2 y b / m o c . s s e comparison of various published studies focusing on AKI difficult and in many cases impossible. Since 2004, at least three proposals have been put forth to define and stage AKI. The RIFLE (Risk, Injury, Failure, Loss, and End-Stage Renal Disease [ESRD]) criteria,7 the first consensus definition, have been studied in a number of settings and have been validated by showing that a stepwise relationship exists between AKI severity and mortality. The Acute Kidney Injury Network (AKIN) criteria modified RIFLE by incorporating an absolute increase in serum creatinine (SCr) after the finding that small increases in SCr of as little as 0.3 mg/dL (26.5 µmol/L) and a time constraint of 48 hours for the diagnosis of AKI were of prognostic significance.8 By considering the changes in SCr values over the first 48 hours, the sensitivity and specificity to detect AKI were increased in the AKIN criteria. However, AKIN criteria could still underestimate AKI in patients for whom the increase in SCr is slow. The current definition by Kidney Disease Improving Global Outcomes .rvdoepww ll.syeuon (frKaDmIeGiOs)existesnidmeidlafrrotom t4h8e hAoKuIrNstode7findiatyiosn.9, Abnutetlheevattiimone /w an of the SCr level exceeding 26.5 µmol/L within 48 hours, / :s o tthp rspe an increase in SCr to 1.5 times the baseline value, which is from roF known or presumed to have occurred within 7 days before, or de a urine volume of ,0.5 mL⋅kg−1⋅h−1 for 6 hours was defined load as AKI. The KDIGO criteria evaluate baseline SCr and, onw therefore, can detect AKI in patients with slow increases in ndg SCr. These criteria provide a simple standardized method igA of categorizing AKI, and they have been assessed in several isn investigations.10–14 However, the clinical implications of a itnon 48-hour or 7-day window for diagnosing AKI in very elderly lItrvnee patiTenhtesreafroeruen,tkhneogwona.ls of the present study were as follows: iilcanC 1d)iacgonmospiasreofthAeKraIt;es2)usaidndgre4s8s-hthoeurkaenydc7l-indiacyalwdinifdfoerwesncfeosr between the 48-hour or 7-day diagnostic window AKI; and 3) examine the effects of 48-hour and 7-day window diagnosis of AKI on short-term mortality. Patients and methods We retrospectively analyzed clinical data from very elderly patients ($75 years of age) who were admitted to the Geriatrics Department of the Chinese PLA General Hospital in Beijing, China, between January 1, 2007, and December 31, 2015. The study design was approved by the Clinical Ethics Commi (...truncated)


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Qinglin Li, Meng Zhao, Xiaodan Wang. AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria, Clinical Interventions in Aging, 2018, pp. 1151-1160, DOI: 10.2147/CIA.S162899