Impact on Outcomes across KDIGO-2012 AKI Criteria According to Baseline Renal Function.

Autor: Acosta-Ochoa I; Department of Nephrology, Hospital Clinico Universitario, 47003 Valladolid, Spain. susty21@hotmail.com., Bustamante-Munguira J; Department of Cardiac Surgery, Hospital Clinico Universitario, 47003 Valladolid, Spain., Mendiluce-Herrero A; Department of Nephrology, Hospital Clinico Universitario, 47003 Valladolid, Spain., Bustamante-Bustamante J; Department of Medicine, Dermatology and Toxicology, School of Medicine, University of Valladolid, 47005 Valladolid, Spain., Coca-Rojo A; Department of Nephrology, Hospital Clinico Universitario, 47003 Valladolid, Spain.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2019 Aug 28; Vol. 8 (9). Date of Electronic Publication: 2019 Aug 28.
DOI: 10.3390/jcm8091323
Abstrakt: Acute kidney injury (AKI) and Chronic Kidney Disease (CKD) are global health problems. The pathophysiology of acute-on-chronic kidney disease (AoCKD) is not well understood. We aimed to study clinical outcomes in patients with previous normal (pure acute kidney injury; P-AKI) or impaired kidney function (AoCKD) across the 2012 Kidney Disease Improving Global Outcomes (KDIGO) AKI classification. We performed a retrospective study of patients with AKI, divided into P-AKI and AoCKD groups, evaluating clinical and epidemiological features, distribution across KDIGO-2012 criteria, in-hospital mortality and need for dialysis. One thousand, two hundred and sixty-nine subjects were included. AoCKD individuals were older and had higher comorbidity. P-AKI individuals fulfilled more often the serum creatinine (SCr) ≥ 3.0× criterion in AKI-Stage3, AoCKD subjects reached SCr ≥ 4.0 mg/dL criterion more frequently. AKI severity was associated with in-hospital mortality independently of baseline renal function. AoCKD subjects presented higher mortality when fulfilling AKI-Stage1 criteria or SCr ≥ 3.0× criterion within AKI-Stage3. The relationship between mortality and associated risk factors, such as the net increase of SCr or AoCKD status, fluctuated depending on AKI stage and stage criteria sub-strata. AoCKD patients that fulfil SCr increment rate criteria may be exposed to more severe insults, possibly explaining the higher mortality. AoCKD may constitute a unique clinical syndrome. Adequate staging criteria may help prompt diagnosis and administration of appropriate therapy.
Databáze: MEDLINE
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