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Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites

The most recent issue of the Journal of Hepatology reports on Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites.

News image

For several years hepatologists have defined acute renal failure in patients with cirrhosis as an increase in serum creatinine 50% to a final value of sCr>1.5mg/dl (conventional criterion).

Recently, the Acute Kidney Injury Network defined acute renal failure as acute kidney injury on the basis of an absolute increase in serum creatinine of 0.3mg/dl or a percentage increase of 50%, providing also a staging from 1 to 3.

Dr Salvatore Piano and colleagues from Italy evaluated Acute Kidney Injury Network stage 1, defined as an increase in serum creatinine of 0.3mg/dl or a 1-2 fold increase in serum creatinine from baseline.

Patients with serum creatinine less than 1.5mg/dl had a lower mortality rate
Journal of Hepatology

Acute Kidney Injury diagnosed with the 2 different criteria was evaluated for the prediction of in-hospital mortality.

Consecutive hospitalized patients with cirrhosis and ascites were included in the study, and evaluated for the development of Acute Kidney Injury.

The doctors also analyzed conventional criterion that was found to be more accurate than Acute Kidney Injury Network criteria in improving the prediction of in-hospital mortality in a model including age and Child-Turcotte-Pugh score.

The addition of either progression of Acute Kidney Injury Network stage or a threshold value for serum creatinine of 1.5mg/dl further improves the value of Acute Kidney Injury Network criteria in this model.

More in detail, patients with AKIN stage 1 and serum creatinine less than 1.5mg/dl had a lower mortality rate, a lower progression rate, and a higher improvement rate than patients with AKIN stage 1 and serum creatinine level of 1.5mg/dl.

Dr Piano's team concludes, "Conventional criterion is more accurate than Acute Kidney Injury Network criteria in the prediction of in-hospital mortality in patients with cirrhosis and ascites."

"The addition of either the progression of Acute Kidney Injury Network stage or the cut-off of serum creatinine of 1.5mg/dl to the Acute Kidney Injury Network criteria improves their prognostic accuracy."

J of Hepatol 2013: 59(3): 482-489
18 September 2013

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