Identification and predicting short-term prognosis of early cardiorenal syndrome type 1: KDIGO is superior to RIFLE or AKIN

Zhilian Li; Lu Cai; Xinling Liang; Zhiming Du; Yuanhan Chen; Shengli An; Ning Tan; Lixia Xu; Ruizhao Li; Liwen Li; Wei Shi

doi:10.1371/journal.pone.0114369

Identification and predicting short-term prognosis of early cardiorenal syndrome type 1: KDIGO is superior to RIFLE or AKIN

PLoS One. 2014 Dec 26;9(12):e114369. doi: 10.1371/journal.pone.0114369. eCollection 2014.

Authors

Zhilian Li¹, Lu Cai², Xinling Liang³, Zhiming Du⁴, Yuanhan Chen¹, Shengli An⁵, Ning Tan⁶, Lixia Xu¹, Ruizhao Li¹, Liwen Li⁶, Wei Shi¹

Affiliations

¹ Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Department of Nephrology, Huzhou Central Hospital, Huzhou, China.
³ Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Southern Medical University, Guangzhou, China.
⁴ Department of Cardiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
⁵ Department of Bio-Statistics, Southern Medical University, Guangzhou, China.
⁶ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou, China.

Abstract

Objective: Acute kidney injury (AKI) in patients hospitalized for acute heart failure (AHF) is usually type 1 of the cardiorenal syndrome (CRS) and has been associated with increased morbidity and mortality. Early recognition of AKI is critical. This study was to determine if the new KDIGO criteria (Kidney Disease: Improving Global Outcomes) for identification and short-term prognosis of early CRS type 1 was superior to the previous RIFLE and AKIN criteria.

Methods: The association between AKI diagnosed by KDIGO but not by RIFLE or AKIN and in-hospital mortality was retrospectively evaluated in 1005 Chinese adult patients with AHF between July 2008 and May 2012. AKI was defined as RIFLE, AKIN and KDIGO criteria, respectively. Cox regression was used for multivariate analysis of in-hospital mortality.

Results: Within 7 days on admission, the incidence of CRS type 1 was 38.9% by KDIGO criteria, 34.7% by AKIN, and 32.1% by RIFLE. A total of 110 (10.9%) cases were additional diagnosed by KDIGO criteria but not by RIFLE or AKIN. 89.1% of them were in Stage 1 (AKIN) or Stage Risk (RIFLE). They accounted for 18.4% (25 cases) of the overall death. After adjustment, this proportion remained an independent risk factor for in-hospital mortality [odds ratios (OR)3.24, 95% confidence interval(95%CI) 1.97-5.35]. Kaplan-Meier curve showed AKI patients by RIFLE, AKIN, KDIGO and [K(+)R(-)+K(+)A(-)] had lower hospital survival than non-AKI patients (Log Rank P<0.001).

Conclusion: KDIGO criteria identified significantly more CRS type 1 episodes than RIFLE or AKIN. AKI missed diagnosed by RIFLE or AKIN criteria was an independent risk factor for in-hospital mortality, indicating the new KDIGO criteria was superior to RIFLE and AKIN in predicting short-term outcomes in early CRS type 1.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cardio-Renal Syndrome / diagnosis*
Cardio-Renal Syndrome / mortality*
Early Diagnosis
Female
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Prognosis
Regression Analysis
Retrospective Studies
Risk Factors

Grants and funding

This study was supported by grants from the National Natural Science Foundation (81170683 and 81200544), the Science and Technique Project of Guangzhou City (2013J4100064), the National Key Technology R&D Program (2011BAI10B08), and the National Clinical Key Specialty Construction Preparatory Projects, China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.