Back to Search
Start Over
Diagnosis and outcomes of acute kidney injury using surrogate and imputation methods for missing preadmission creatinine values
- Source :
- BMC Nephrology, Vol 18, Iss 1, Pp 1-9 (2017), BMC Nephrology
- Publication Year :
- 2017
- Publisher :
- BMC, 2017.
-
Abstract
- Background Missing preadmission serum creatinine (SCr) values are a common obstacle to assess acute kidney injury (AKI) diagnosis and outcomes. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest using a SCr computed from the Modification of Diet in Renal Disease (MDRD) with an estimated glomerular filtration rate of 75 ml/min/1.73 m2. We aimed to identify the best surrogate method for baseline SCr to assess AKI diagnosis and outcomes. Methods We compared the use of 1) first SCr at hospital admission 2) minimal SCr over 2 weeks after intensive care unit admission 3) MDRD computed SCr and 4) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) computed SCr to assess AKI diagnosis and outcomes. We then performed multilinear regression models to predict preadmission SCr and imputation strategies to assess AKI diagnosis. Results Our one-year retrospective cohort study included 1001 critically ill adults; 498 of them had preadmission SCr values. In these patients, AKI incidence was 25.1% using preadmission SCr. First SCr had the best agreement for AKI diagnosis (22.5%; kappa = 0.90) and staging (kappa = 0.81). MDRD, CKD-EPI and minimal SCr overestimated AKI diagnosis (26.7%, 27.1% and 43.2%;kappa = 0.86, 0.86 and 0.60, respectively). However, MDRD and CKD-EPI computed SCr had a better sensitivity than first SCr for AKI (93% and 94% vs. 87%). Eighty-eight percent of patients experienced renal recovery at least 3 months after hospital discharge. All methods except the first SCr significantly underestimated the percentage of renal recovery. In a multivariate model, age, male gender, hypertension, heart failure, undergoing surgery and log first SCr best predicted preadmission SCr (adjusted R2 = 0.56). Imputation methods with first SCr increased AKI incidence to 23.9% (kappa = 0.92) but not with MDRD computed SCr (26.7%;kappa = 0.89). Conclusion In our cohort, first SCr performed better for AKI diagnosis and staging, as well as for renal recovery after hospital discharge than MDRD, CKD-EPI or minimal SCr. However, MDRD SCr and CKD-EPI SCr improved AKI diagnosis sensitivity. Imputation methods minimally increased agreement for AKI diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0552-3) contains supplementary material, which is available to authorized users.
- Subjects :
- Nephrology
Male
Epidemiology
030232 urology & nephrology
Kidney Function Tests
urologic and male genital diseases
lcsh:RC870-923
law.invention
Cohort Studies
chemistry.chemical_compound
0302 clinical medicine
Patient Admission
law
Outcome Assessment, Health Care
Diagnosis
Prevalence
Medicine
030212 general & internal medicine
Longitudinal Studies
Acute kidney injury
Quebec
Surrogate
Middle Aged
Prognosis
Intensive care unit
female genital diseases and pregnancy complications
Treatment Outcome
Creatinine
Baseline creatinine
Cohort
Female
Research Article
medicine.medical_specialty
Renal function
Outcomes
Sensitivity and Specificity
behavioral disciplines and activities
03 medical and health sciences
Internal medicine
Humans
Aged
Retrospective Studies
business.industry
Reproducibility of Results
Retrospective cohort study
medicine.disease
lcsh:Diseases of the genitourinary system. Urology
chemistry
business
Biomarkers
Kidney disease
Subjects
Details
- Language :
- English
- ISSN :
- 14712369
- Volume :
- 18
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Nephrology
- Accession number :
- edsair.doi.dedup.....56726f4d86990059d059276c2741a150