Renal failure in patients admitted to the ICU is associated with increased mortality. The Acute Kidney Injury Network (AKIN) has recently proposed modifications of existing criteria to improve the sensitivity of the diagnosis of acute kidney injury. We conducted a study to evaluate the prognostic value of AKIN criteria to predict the outcomes of acute renal failure in critically ill patients.
We conducted an observational, prospective study enrolling all patients admitted to MICU between October 2008 and December 2008. Renal function, based on serum creatinine, was monitored daily during their stay in ICU and patients were categorized into 3 groups: Group A –No renal Failure, Group B –Renal Failure by AKIN (rise of creatinine by 0.3mg/dl), Group C –Renal failure as per both AKIN and standard criteria (rise of creatinine by 1.5 times baseline). In hospital mortality was the primary end point. Secondary end points were length of stay in ICU, length of stay in hospital and need for renal replacement therapy.
107 patients with mean age of 74 admitted to ICU were enrolled. 35 had no renal failure on admission (Group A), 31 patients had renal failure as per AKIN criteria (Group B), and 41 had renal failure as per AKIN and standard criteria (Group C). In hospital mortality in group B patients was significantly higher (22.6%) as compared with Group A (5.4%) (p = 0.0425). 12.9% of group B patients required renal replacement therapy (p = 0.0386). The hospital length of stay for Group A and Group B was 14.8 days and 21.3 days respectively. The ICU length of stay for Group A and Group B was 6.62 days and 8.45 days respectively.
Early renal failure as identified by AKIN criteria is associated with increased mortality and morbidity as well as prolonged ICU and hospital lengths of stay.
Identification of early renal failure by AKIN criteria should prompt early intervention to prevent worsening renal function.
Prashant Gundre, No Financial Disclosure Information; No Product/Research Disclosure Information