The calculation of baseline serum creatinine overestimates the diagnosis of acute kidney injury in patients undergoing cardiac surgery
The calculation of baseline serum creatinine overestimates the diagnosis of acute kidney injury in patients undergoing cardiac surgery
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DOI：
10.3265/nefrologia.pre2011.oct.11102
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发表时间：
2012-01-01
期刊：
影响因子：
--
通讯作者：
Tenorio, T.
中科院分区：
文献类型：
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作者：
Candela-Toha, A.M.;Recio-Vázquez, M.;Tenorio, T.
引言和目的：目前急性肾损伤的定义和分类基于共识标准（步枪和AKIN系统）。肌酐是最常用的推荐参数（肌酐、肾小球滤过率和利尿）。如果基线值未知，可根据简化的MDRD公式计算，假设计算时的滤过率为75 ml/min/1.73 m（2）。本研究的目的是评估使用估计的基线肌酐的诊断影响相比，在接受心脏手术的患者的实际测量值方法：分析接受大型心脏手术的患者，谁是前瞻性的数据库。使用测量和估计的基线肌酐水平计算每例患者达到的最大步枪分期。使用组内相关系数、一致性分析和Bland-Altman图分析对诊断的影响。结果如下：2002年至2007年期间，2103例患者术后急性肾损伤的发生率为29.1%，根据估计的肌酐（14.3%的测量）。这表示高估了104%，组内相关性为0.12。通过排除已知慢性肾脏疾病患者（肾小球滤过率[<60 ml/min/1.73 m（2）]），高估率（2.4%）和相关性（0.57）均得到改善。结论：使用MDRD方程计算基线肌酐高估了心脏手术后急性肾损伤的发生率，并且当基线值未知时，这是一种不适当的检测方法。
Introduction and objectives: The current definition and classification of acute kidney injury is based on consensus criteria (RIFLE and AKIN systems). Creatinine is the most commonly used of the recommended parameters (creatinine, glomerular filtration rate and diuresis). If the baseline value is not known, it can be calculated based on the simplified MDRD equation, assuming a filtration rate of 75ml/min/1.73m(2) for the calculation. The aim of this study was to evaluate the diagnostic impact of using estimated baseline creatinine compared to the actual value measured in patients undergoing cardiac surgery Methods: Analysis of patients undergoing major cardiac surgery, who were prospectively included in a database. The maximum RIFLE stage reached was calculated for each patient using the measured and estimated baseline creatinine levels. The impact on the diagnosis was analysed using intraclass correlation coefficients, concordance analysis and Bland-Altman plots. Results: The incidence of postoperative acute kidney injury in 2103 cases between 2002 and 2007 was 29.1%, according to estimated creatinine (14.3% with the measure). This represents an overestimation of 104%, with an intraclass correlation of 0.12. By excluding patients with known chronic kidney disease (glomerular filtration rate [< 60ml/min/1.73m(2)), both the overestimation (2.4%) and the correlation (0.57) improved. Conclusions: The calculation of baseline creatinine using the MDRD equation overestimates the incidence of acute kidney injury after cardiac surgery, and is an inadequate method for detection when the baseline value is unknown.