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BMC Nephrol. 2017 Apr 28;18(1):141. doi: 10.1186/s12882-017-0552-3.

Diagnosis and outcomes of acute kidney injury using surrogate and imputation methods for missing preadmission creatinine values.

Author information

1
Department of Medicine, Division of Nephrology, Sacre-Coeur Hospital of Montreal, 5400 Gouin Blvd West, Montreal, Quebec, H4J 1C5, Canada.
2
Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
3
Department of Medicine, Division of Nephrology, Sacre-Coeur Hospital of Montreal, 5400 Gouin Blvd West, Montreal, Quebec, H4J 1C5, Canada. josee.bouchard.1@umontreal.ca.
4
Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada. josee.bouchard.1@umontreal.ca.

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.

KEYWORDS:

Acute kidney injury; Baseline creatinine; Diagnosis; Epidemiology; Outcomes; Surrogate

PMID:
28454562
PMCID:
PMC5410063
DOI:
10.1186/s12882-017-0552-3
[Indexed for MEDLINE]
Free PMC Article

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