The urine output definition of acute kidney injury is too liberal

INTRODUCTION: The urine output criterion of 0.5 ml/kg/h for 6-hours for acute kidney injury, (AKI) has not been prospectively validated. Urine output criteria for AKI (AKIUO) as predictors of in-hospital mortality or dialysis need were compared. METHODS: All admissions to a general ICU were prosp...

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Main Authors:	Md Ralib, Azrina, Pickering, John W., Shaw, Geoffrey M., Endre, Zoltan H.
Format:	Article
Language:	English
Published:	Critical Care Forum 2013
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/32041/ http://irep.iium.edu.my/32041/ http://irep.iium.edu.my/32041/1/cc12784.pdf

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spelling	iium-320412013-09-25T08:45:45Z http://irep.iium.edu.my/32041/ The urine output definition of acute kidney injury is too liberal Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Endre, Zoltan H. R Medicine (General) INTRODUCTION: The urine output criterion of 0.5 ml/kg/h for 6-hours for acute kidney injury, (AKI) has not been prospectively validated. Urine output criteria for AKI (AKIUO) as predictors of in-hospital mortality or dialysis need were compared. METHODS: All admissions to a general ICU were prospectively screened for 12 months and hourly urine output analysed in collection intervals between 1 and 12 hours. Prediction of the composite of mortality or dialysis by urine output was analysed in increments of 0.1 ml/kg/h from 0.1 to 1 ml/kg/h and the optimal threshold for each collection interval determined. AKICr was defined as an increase in plasma creatinine of [greater than or equal to]26.5 mol/l within 48 hours or [greater than or equal to]50% from baseline. RESULTS: Of 725 admissions, 72% had either AKICr or AKIUO or both. AKIUO (33.7%) alone was more frequent than AKICr (11.0%) alone (P<0.0001). A 6-hour urine output collection threshold of 0.3 ml/kg/h was associated with a step increase in in-hospital mortality or dialysis (from 10% above to 30% less than 0.3 ml/kg/h). Hazard Ratios for in-hospital and one-year mortality were 2.25 (1.40 to 3.61) and 2.15 (1.47 to 3.15) respectively after adjustment for age, body weight, severity of illness, fluid balance, and vasopressor use. In contrast, after adjustment AKIUO was not associated with in-hospital or 1-year mortality. The optimal urine output threshold was linearly related to duration of urine collection (r2=0.93). CONCLUSIONS: A 6-hour urine output threshold of 0.3 ml/kg/h best associated with mortality and dialysis and was independently predictive of both hospital and 1-year mortality. This suggests that the current AKI urine output definition is too liberally defined. Shorter urine collection intervals may be used to define AKI using lower urine output thresholds. Critical Care Forum 2013-06-20 Article PeerReviewed application/pdf en http://irep.iium.edu.my/32041/1/cc12784.pdf Md Ralib, Azrina and Pickering, John W. and Shaw, Geoffrey M. and Endre, Zoltan H. (2013) The urine output definition of acute kidney injury is too liberal. Critical Cara, 79 (5). pp. 370-379. ISSN 1466-609X http://ccforum.com/content/17/3/R112/abstract
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Endre, Zoltan H. The urine output definition of acute kidney injury is too liberal
description	INTRODUCTION: The urine output criterion of 0.5 ml/kg/h for 6-hours for acute kidney injury, (AKI) has not been prospectively validated. Urine output criteria for AKI (AKIUO) as predictors of in-hospital mortality or dialysis need were compared. METHODS: All admissions to a general ICU were prospectively screened for 12 months and hourly urine output analysed in collection intervals between 1 and 12 hours. Prediction of the composite of mortality or dialysis by urine output was analysed in increments of 0.1 ml/kg/h from 0.1 to 1 ml/kg/h and the optimal threshold for each collection interval determined. AKICr was defined as an increase in plasma creatinine of [greater than or equal to]26.5 mol/l within 48 hours or [greater than or equal to]50% from baseline. RESULTS: Of 725 admissions, 72% had either AKICr or AKIUO or both. AKIUO (33.7%) alone was more frequent than AKICr (11.0%) alone (P<0.0001). A 6-hour urine output collection threshold of 0.3 ml/kg/h was associated with a step increase in in-hospital mortality or dialysis (from 10% above to 30% less than 0.3 ml/kg/h). Hazard Ratios for in-hospital and one-year mortality were 2.25 (1.40 to 3.61) and 2.15 (1.47 to 3.15) respectively after adjustment for age, body weight, severity of illness, fluid balance, and vasopressor use. In contrast, after adjustment AKIUO was not associated with in-hospital or 1-year mortality. The optimal urine output threshold was linearly related to duration of urine collection (r2=0.93). CONCLUSIONS: A 6-hour urine output threshold of 0.3 ml/kg/h best associated with mortality and dialysis and was independently predictive of both hospital and 1-year mortality. This suggests that the current AKI urine output definition is too liberally defined. Shorter urine collection intervals may be used to define AKI using lower urine output thresholds.
format	Article
author	Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Endre, Zoltan H.
author_facet	Md Ralib, Azrina Pickering, John W. Shaw, Geoffrey M. Endre, Zoltan H.
author_sort	Md Ralib, Azrina
title	The urine output definition of acute kidney injury is too liberal
title_short	The urine output definition of acute kidney injury is too liberal
title_full	The urine output definition of acute kidney injury is too liberal
title_fullStr	The urine output definition of acute kidney injury is too liberal
title_full_unstemmed	The urine output definition of acute kidney injury is too liberal
title_sort	urine output definition of acute kidney injury is too liberal
publisher	Critical Care Forum
publishDate	2013
url	http://irep.iium.edu.my/32041/ http://irep.iium.edu.my/32041/ http://irep.iium.edu.my/32041/1/cc12784.pdf
first_indexed	2023-09-18T20:46:13Z
last_indexed	2023-09-18T20:46:13Z
_version_	1777409693055975424

The urine output definition of acute kidney injury is too liberal

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