2008-05Acute kidney injury criteria predict outcomes of critically ill patients.pdf

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2008-05Acute kidney injury criteria predict outcomes of critically ill patients.pdf

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2008-05Acute kidney injury criteria predict outcomes of critically ill patients

Feature Articles Acute kidney injury criteria predict outcomes of critically ill patients* Fidel Barrantes, MD; Jianmin Tian, MD, MPH; Rodrigo Vazquez, MD; Yaw Amoateng-Adjepong, MD, PhD; Constantine A. Manthous, MD Renal dysfunction is a commoncause or complication of crit-ical illness and is associatedwith excess morbidity and mortality (1–11). To date, there is no universally accepted definition for acute kidney dysfunction. Varying terms, in- cluding acute renal failure, renal insuffi- ciency, kidney injury, and renal impair- ment, and various definitions (e.g., percent or absolute increments of creat- inine, or decrements of urine output) have been used in previous publications. To the extent that nonuniform defini- tions hinder scientific inquiry (11, 12), formulation of robust, scientifically valid definitions may expedite future studies of the epidemiology, pathophysiology, and treatment of renal failure. The Acute Kidney Injury Network (AKIN) consists of nephrologists and in- tensive care physicians who have orga- nized efforts to promote a single, scien- tifically valid definition to promote the quality of further scientific inquiry into the pathogenesis of renal failure. In Sep- tember 2005, AKIN invited representa- tives of international nephrology and critical care societies to Amsterdam for a 3-day conference, the purpose of which was to review the medical literature and formulate/ratify a consensus working def- inition of acute kidney injury (AKI). After 2 days of scientific presentations, the group deliberated and ratified the follow- ing interim diagnostic criteria of AKI: “An abrupt (within 48 hrs) reduction in kidney function currently defined as an absolute increase in serum creatinine of either 0.3 mg/dL (26.4 mol/L) or a percentage increase of 50% (1.5-fold from baseline) or a reduction in urine output (documented oliguria of 0.5 mL/kg/hr for 6 hrs)” (12). It was ex- plicitly suggested that these criteria should be used in “the context of