Kinetic estimated glomerular filtration rate in critically ill patients: beyond the acute kidney injury severity classification system

Abstract

Background: Although significant advances have been achieved in acute kidney injury (AKI) research following its classification, potential pitfalls can be identified in clinical practice. The nonsteady-state (kinetic) estimated glomerular filtration rate (KeGFR) could add clinical and prognostic information in critically ill patients beyond the current AKI classification system. Methods: This was a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II project. The KeGFR was calculated during the first 7 days of intensive care unit (ICU) stay in 13,284 patients and was correlated with outcomes. Results: In general, there was not a good agreement between AKI severity and the worst achieved KeGFR. The stepwise reductionintheworstachievedKeG FR conferred an incremental risk of death, rising from 7.0% (KeGFR > 70 ml/min/1.73 m 2 ) to 27.8% (KeGFR < 30 ml/min/1.73 m 2 ). This stepwise increment in mortality remained in each AKI severity stage. For example, patients with AKI stage 3 who maintained KeGFR had a mortality rate of 16.5%, close to those patients with KeGFR < 30 ml/min/1.73 m 2 butnoAKI;otherwise,mortalityincreased to 40% when both AKI stage 3 and KeGFR < 30 ml/min/1.73 m 2 were present. In relation to another outcome — renal replacement therapy (RRT) — patients with the worst achi eved KeGFR < 30 ml/min/1.73 m 2 and KDIGO stage 1/2 had a rate of RRT of less than 10%. However, this rate was 44% when both AKI stage 3 and a worst KeGFR < 30 ml/min/1.73 m 2 were observed. This interaction between AKI and KeGFR was also present when looking at long-term survival. Conclusion: Both the AKI classification system and KeGFR ar e complementary to each other. Assessing both AKI stage and KeGFR can help to identify patients at different risk levels in clinical practice.