Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors
Background. Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is de...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/7698090 |
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| author | Claire Rimes-Stigare Bo Ravn Akil Awad Klara Torlén Claes-Roland Martling Matteo Bottai Johan Mårtensson Max Bell |
| author_facet | Claire Rimes-Stigare Bo Ravn Akil Awad Klara Torlén Claes-Roland Martling Matteo Bottai Johan Mårtensson Max Bell |
| author_sort | Claire Rimes-Stigare |
| collection | DOAJ |
| description | Background. Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is defined as the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 persisting for more than 90 days. We compared CKD incidence using both creatinine- and cystatin C-based GFR with AKD incidence at 90 days in AKI survivors. Methods. A prospective cohort study was conducted in a Swedish intensive care unit (ICU) between 2008 and 2010. We included AKI patients alive at 90 days. We excluded patients <18 and >100 years, death before follow-up, CKD prior to admission, and follow-up before 60 days or beyond 270 days. Creatinine and cystatin C were measured at 90 days and converted to eGFR (mL/min/1.73 m2). Results. We included 274 patients. At 90-day follow-up, the median creatinine eGFR (MDRD) was 81.6 (IQR 58.6–106.8) and median cystatin C eGFR was 51.5 (IQR 35.8–70.7). The incidence of CKD (eGFR < 60) was 25.8% based on creatinine but 63.7% using cystatin C estimates. AKD was present in 47 patients (18.9%). Age, discharge cystatin C, creatinine at discharge, and female gender predicted creatinine-defined CKD at follow-up. Age, discharge cystatin C, CRRT on ICU, and diabetes were associated with cystatin C-based CKD. Conclusions. In AKI survivors followed up at 3 months, CKD criteria were met in a quarter of patients using creatinine and in two-thirds using cystatin C eGFR. Less than one-fifth of patients fulfilled AKD criteria. The application of AKD criteria may underestimate renal dysfunction in AKI survivors. |
| format | Article |
| id | doaj-art-b2f8a4cad5c8487c85bcbd18bf198a00 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-b2f8a4cad5c8487c85bcbd18bf198a002025-02-03T05:46:52ZengWileyCritical Care Research and Practice2090-13052090-13132018-01-01201810.1155/2018/76980907698090Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI SurvivorsClaire Rimes-Stigare0Bo Ravn1Akil Awad2Klara Torlén3Claes-Roland Martling4Matteo Bottai5Johan Mårtensson6Max Bell7Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, SwedenSection of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, SwedenDepartment of Cardiology, Södersjukhuset, Stockholm, SwedenDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, SwedenSection of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, SwedenDivision of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, SwedenSection of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, SwedenSection of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, SwedenBackground. Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is defined as the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 persisting for more than 90 days. We compared CKD incidence using both creatinine- and cystatin C-based GFR with AKD incidence at 90 days in AKI survivors. Methods. A prospective cohort study was conducted in a Swedish intensive care unit (ICU) between 2008 and 2010. We included AKI patients alive at 90 days. We excluded patients <18 and >100 years, death before follow-up, CKD prior to admission, and follow-up before 60 days or beyond 270 days. Creatinine and cystatin C were measured at 90 days and converted to eGFR (mL/min/1.73 m2). Results. We included 274 patients. At 90-day follow-up, the median creatinine eGFR (MDRD) was 81.6 (IQR 58.6–106.8) and median cystatin C eGFR was 51.5 (IQR 35.8–70.7). The incidence of CKD (eGFR < 60) was 25.8% based on creatinine but 63.7% using cystatin C estimates. AKD was present in 47 patients (18.9%). Age, discharge cystatin C, creatinine at discharge, and female gender predicted creatinine-defined CKD at follow-up. Age, discharge cystatin C, CRRT on ICU, and diabetes were associated with cystatin C-based CKD. Conclusions. In AKI survivors followed up at 3 months, CKD criteria were met in a quarter of patients using creatinine and in two-thirds using cystatin C eGFR. Less than one-fifth of patients fulfilled AKD criteria. The application of AKD criteria may underestimate renal dysfunction in AKI survivors.http://dx.doi.org/10.1155/2018/7698090 |
| spellingShingle | Claire Rimes-Stigare Bo Ravn Akil Awad Klara Torlén Claes-Roland Martling Matteo Bottai Johan Mårtensson Max Bell Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors Critical Care Research and Practice |
| title | Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors |
| title_full | Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors |
| title_fullStr | Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors |
| title_full_unstemmed | Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors |
| title_short | Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors |
| title_sort | creatinine and cystatin c based incidence of chronic kidney disease and acute kidney disease in aki survivors |
| url | http://dx.doi.org/10.1155/2018/7698090 |
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