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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Int+J+Nephrol+Renovasc+Dis
2016 ; 9
(ä): 257-262
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gab.com Text
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Acute kidney injury adjusted to volume status in critically ill patients:
recognition of delayed diagnosis, restaging, and associated outcomes
#MMPMID27822078
Yacoub H
; Khoury L
; El Douaihy Y
; Salmane C
; Kamal J
; Saad M
; Nasr P
; Radbel J
; El-Charabaty E
; El-Sayegh S
Int J Nephrol Renovasc Dis
2016[]; 9
(ä): 257-262
PMID27822078
show ga
Critically ill patients receive a significant amount of fluids leading to a
positive fluid balance; this dilutes serum creatinine resulting in an
overestimated glomerular filtration rate. The goal of our study is to identify
undiagnosed or underestimated acute kidney injury (AKI) in the intensive care
unit (ICU). It will also identify the morbidity and mortality associated with an
underestimated AKI. We reviewed records of patients admitted to our institution
(Staten Island University Hospital) between 2012 and 2013 for more than 2 days.
Patients with end stage renal disease were excluded. AKI was defined using the
Acute Kidney Injury Network criteria. The following formula was used to identify
and restage patients with AKI: adjusted creatinine = serum creatinine ×
[(hospital admission weight (kg) 0.6 + ? (daily cumulative fluid balance
(L))/hospital admission weight × 0.6]. The primary outcome identified newly
diagnosed AKI and those who were restaged. The secondary outcome identified
associated morbidities. Seven-hundred and thirty-three out of 1,982 ICU records
reviewed, were used. Two-hundred and fifty-seven (mean age 69.8±14.9) had AKI,
out of which 15.9% were restaged using the equation. Comparison of mean by
Student's t-test showed no difference between patients who were restaged.
Similarly, chi-square revealed no differences between both arms, except mean
admission weight (lower in patients who were restaged), fluid balance on days 1,
2, and 3 (higher in the restaged arm), and the presence of congestive heart
failure (more prevalent in the restaged arm). Of note, the mean cost of stay was
US$150,562.82 vs $197,174.63 for same stage vs restaged, respectively, however,
without statistical significance (P=0.74). Applying the adjustment equation
showed a modest (15.9%) increase in the AKI staging slightly impacting outcomes
(mortality, length, and cost of stay) without statistical significance.