Background
AKI risk factors |
---|
Advanced age |
Diabetes |
Hypertension |
Chronic kidney disease |
Cardiovascular disease |
Liver disease |
Lung disease |
Disease severity |
Shock |
Sepsis |
Nephrotoxins |
Surgery |
AKI definition and biomarkers
Class/stage | SCr/GFR | UO | ||||
---|---|---|---|---|---|---|
RIFLE | AKIN | KDIGO | RIFLE | AKIN | KDIGO | |
Risk/1a | ↑ SCr X 1.5 or ↓ GFR > 25% | ↑ SCr ≥ 26.5 μmol/l (≥ 0.3 mg/dl) or ↑ SCr ≥ 150 to 200% (1.5 to 2X) | ↑ SCr ≥ 26.5 μmol/l (≥ 0.3 mg/dl) or ↑ SCr ≥ 150 to 200% (1.5 to 2X) | < 0.5 ml/kg/h (> 6 h) | < 0.5 ml/kg/h (> 6 h) | < 0.5 ml/kg/h (> 6 h) |
Injury/2a | ↑ SCr X 2 or ↓ GFR > 50% | ↑ SCr > 200 to 300% (> 2 to 3X) | ↑ SCr > 200 to 300% (> 2 to 3X) | < 0.5 ml/kg/h (> 12 h) | < 0.5 ml/kg/h (> 12 h) | < 0.5 ml/kg/h (> 12 h) |
Failure/3a | ↑ SCr X 3 or ↓ GFR > 75% or if baseline SCr ≥ 353.6 μmol/l (≥4 mg/dl) ↑ SCr > 44.2 μmol/l (> 0.5 mg/dl) | ↑ SCr > 300% (> 3X) or if baseline SCr ≥ 353.6 μmol/l (≥ 4 mg/dl) ↑SCr ≥ 44.2 μmol/l (≥ 0.5 mg/dl) or initiation of renal replacement therapy | ↑ SCr > 300% (> 3X) or ↑SCr to ≥ 353.6 μmol/l (≥ 4 mg/dl) or initiation of renal replacement therapy | < 0.3 ml/kg/h (> 24 h) or anuria (> 12 h) | < 0.3 ml/kg/h (24 h) or anuria (12 h) | < 0.3 ml/kg/h (24 h) or anuria (12 h) |
Pathophysiology of AKI
Study | Design | Setting |
N
| AKI definition | Incidence of AKI | Mortality |
---|---|---|---|---|---|---|
Anemia | ||||||
Shema-Didi et al. [50] | Retrospective | Hospitalized | 34,802 | RIFLE | OR 1.5 (1.4–1.6), p < 0.001 | OR 6.3 (4.6–8.5), p < 0.001 |
Karkouti et al. [56] | Retrospective | Post-cardiac surgery | 1444 | SCr ≥ 50% | RR 2.6 (2.0–3.3) | |
Shacham et al. [51] | Retrospective | Post-acute myocardial infarction | 1248 | AKIN | OR 1.76 (1.02–3.02), p = 0.04 | |
Han et al. [53] | Retrospective | Critically ill | 2145 | KDIGO | OR 1.76 (1.349–2.291), p < 0.001 | OR 2.21 (1.835–2.662), p < 0.001 |
Arai et al. [59] | Prospective | Post-transcatheter aortic valve implantation | 3472 | Valve Academic Research Consortium criteria | OR 1.82 (1.45–2.29), p < 0.01 | HR 1.5 (1.29–1.73), p < 0.01 |
Powell-Tuck et al. [54] | Retrospective | Critically ill | 210 | AKIN | OR 0.82 (0.65–1.03), p = 0.09 | |
Abusaada et al. [52] | Prospective | Post-acute myocardial infarction | 1107 | AKIN | OR 1.66 (1.07–2.54), p = 0.022 | |
Choi et al. [61] | Retrospective | Post-total hip replacement arthroplasty | 2467 | AKIN | OR 2.036 (1.369–3.028), p < 0.001 | |
Malhotra et al. [55] | Prospective | Critically ill | 573 | KDIGO | OR 1.477 (0.891–2.449), p = 0.13 | |
Duque-Sosa et al. [57] | Retrospective | Post-cardiac surgery | 966 | KDIGO | OR 1.32 (1.00–1.75), p = 0.05 | |
Gorla et al. [60] | Retrospective | Post-thoracic endovascular aortic repair | 144 | AKIN | OR 4.34 (1.91–9.85), p < 0.001 | OR 1.67 (1.03–2.68), p = 0.036 |
Oprea et al. [58] | Retrospective | Post-cardiac surgery | 6130 | KDIGO | HR 1.15 (1.01 to 1.32), p = 0.04 | HR 1.50 (1.25 to 1.79), p < 0.001 |
Sreenivasan et al. [62] | Retrospective | Post-coronary angiography | 2055 | KDIGO | OR 5.3 (3.8–7.3), p < 0.001 | |
White blood cell count | ||||||
Han et al. [63] | Prospective | Critically ill | 2079 | KDIGO |
Leucocytosis
OR 2.05 (1.39–3.031), p < 0.001
Leucopenia
OR 1.42 (1.002–1.996), p = 0.048 |
Leucocytosis
OR 1.36 (0.992–1.852), p = 0.056
Leucopenia
OR 1.40 (1.025–1.912), p = 0.035 |
Delta-neutrophil index | ||||||
Kim et al. [64] | Retrospective | Sepsis-associated AKI | 346 | AKIN | OR 1.060, p < 0.001 | HR 25.2, p < 0.001 |
Neutrophil-to-lymphocyte ratio | ||||||
Kim et al. [65] | Retrospective | Post-cardiovascular surgery | 590 | KDIGO | NLR > 4.5 OR 3.26 (1.51–7.06), p = 0.003 | HR 1.02 (1.01–1.04), p = 0.006 |
Yilmaz et al. [69] | Retrospective | Septic patients | 118 | AKIN | OR 3.25 (2.72–4.19), p < 0.001 | |
Yuan et al. [68] | Retrospective | Post-coronary angiography | 1162 | SCr ≥ 0.5 within 3 days | OR 1.105 (1.044–1.169), p = 0.001 | |
Alfeilat et al. [72] | Prospective | Emergency department | 294 | AKIN/KDIGO | NLR > 5.5 OR 6.4 (2.7–16), p = 0.031 | |
Gameiro et al. [73] | Retrospective | Cirrhotic patients | 186 | SCr ≥ 0.3 in 48 h or SCr ≥ 50% | OR 1.1 (1.0–1.1), p = 0.028; NLR > 6 OR 2.4 (1.0–5.8), p = 0.041 | |
Parlar et al. [66] | Retrospective | Post-cardiac surgery | 311 | KDIGO | OR 0.45 (0.22–0.95), p = 0.04 | |
Bu et al. [70] | Retrospective | Septic patients | 132 | KDIGO | OR 1.047 (1.005–1.091), p = 0.026 | |
Kim et al. [67] | Retrospective | Burn-injured patients | 473 | KDIGO | OR 1.094 (1.064–1.125), p < 0.001 | |
Younan et al. [74] | Retrospective | Critically ill trauma | 207 | KDIGO | OR 2.06 (1.04–4.06), p = 0.04 | |
Fan et al. [75] | Retrospective | Critically ill AKI patients | 13,678 | KDIGO | NLR > 12.14 HR 1.83 (1.66–2.02), p < 0.0001 | |
Mean platelet volume | ||||||
Han et al. [76] | Retrospective | Critically ill AKI–CRRT patients | 349 | Clinical evaluation | HR 1.08 (1.010–1.155), p = 0.023 | |
Mean platelet ratio | ||||||
Li et al. [78] | Retrospective | Critically ill AKI–CRRT patients | 223 | KDIGO | AUROC 0.636 (0.563–0.708), p < 0.001 | |
Thrombocytopenia | ||||||
Van Linden et al. [81] | Retrospective | Post-trans-apical aortic valve implantation | 270 | RIFLE | OR 4.4 (1.6–12.2), p = 0.005 | |
Fan et al. [83] | Retrospective | Heat stroke patients | 176 | Clinical evaluation | OR 37.92 (2.18–87.21), p < 0.01 | |
Kertai et al. [82] | Retrospective | Post-cardiac surgery | 4217 | KDIGO | OR 1.14 (1.09–1.20), p < 0.0001 | HR 5.46 (3.79–7.89), p < 0.0001 |
Chao et al. [84] | Prospective | Emergency department, elderly | 136 | KDIGO | HR 1.85 (1.05–3.28), p = 0.03 | |
Wu et al. [85] | Retrospective | Hemorrhagic shock patients | 84 | KDIGO | OR 0.71 (0.54–0.93), p < 0.05 | HR 0.89 (0.76–0.99), p < 0.05 |
Neutrophil, lymphocyte and platelet ratio | ||||||
Gameiro et al. [87] | Retrospective | Post-abdominal surgery | 450 | KDIGO | OR 1.05 (1.00–1.10), p = 0.048 | |
Koo et al. [86] | Retrospective | Post-cardiac surgery | 1099 | KDIGO | OR 1.19 (1.04–1.36), p = 0.0124; NLPR ≥ 64 OR 2.18 (1.20–3.98), p = 0.011 | NLPR > 3 HR 3.54 (2.00–6.28), p < 0.001 |
Platelet-to-lymphocyte ratio | ||||||
Hudzik et al. [89] | Retrospective | Post-acute myocardial infarction, diabetic patients | 719 | KDIGO | OR 1.22 (1.10–1.34), p < 0.0001 | |
Zheng et al. [91] | Retrospective | Critically ill AKI patients | 10,859 | KDIGO | PLR < 90 HR 1.25 (1.12–1.39), p < 0.001 PLR > 311 HR 1.19 (1.08–1.31), p < 0.001 | |
Sun et al. [90] | Retrospective | Post-acute myocardial infarction, coronary angiography | 5719 | SCr > 25% or > 0.5 mg/dl within 72 h of contrast exposure | OR 1.432 (1.205–1.816,) p = 0.031 | |
Parlar et al. [66] | Retrospective | Post-cardiac surgery | 311 | KDIGO | OR 1.06 (1.01–1.10), p = 0.01 |