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Prognostic utility of the acute kidney injury network (AKIN) criteria for acute kidney injury in myeloablative haematopoietic cell transplantation

Bone Marrow Transplantation volume 40, pages 1005–1006 (2007)Cite this article

In a previous study,1 we demonstrated the ability of RIFLE (‘Risk’, ‘Injury’, ‘Failure’, ‘Loss of kidney function’, ‘End-stage kidney disease’) classification for acute kidney injury (AKI)2 in predicting mortality of patients undergoing myeloablative haematopoietic cell transplantation (HCT). A more recent classification for AKI3 based on RIFLE has been proposed by the Acute Kidney Injury Network (AKIN). This newly staging system (Table 1) differs from RIFLE as follows: it reduces the need for a baseline creatinine but does require at least two creatinine values within 48 h; AKI is defined as an abrupt (within 48 h) reduction in kidney function currently defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl (⩾26.4 μmol/l), a percentage increase in serum creatinine of more than or equal to 50% (1.5-fold from baseline), or a reduction in urine output (documented oliguria >0.5 ml/kg per h for more than 6 h); ‘Risk’ maps to stage 1, but it also considers an increase in serum creatinine of more than or equal to 0.3 mg/dl (⩾26.4 μmol/l); ‘Injury’ and ‘Failure’ map to stages 2 and 3, respectively; stage 3 also includes patients who need renal replacement therapy irrespective of the stage at the time of renal replacement therapy; and the two outcome classes ‘Loss’ and ‘End-stage kidney disease’ have been removed. These modifications could confer greater sensitivity and specificity to this classification, however, to our knowledge, no studies have been published yet validating the AKIN classification. We sought to evaluate the capacity of the AKIN criteria to predict in-hospital mortality in myeloablative HCT by evaluating retrospectively all patients who received a myeloablative autologous or allogeneic HCT in our Hospital between January 2003 and December 2004. Patients were categorized on the basis of serum creatinine or urine output, or both, the criteria that led to the worst classification and the maximum AKIN possible. At least two serum creatinine values within 48 h were considered to define AKI stage. One-hundred and forty patients (86 men, mean age: 32.9±14.69 years) were evaluated: 90 patients received an allogeneic HCT and 50 received an autologous HCT; 82 patients received peripheral blood stem cell transplantation and 58 a bone marrow graft. Acute kidney injury defined by AKIN occurred in 56 patients (40%): 39.3% were in stage 1, 21.4% in stage 2 and 39.3% in stage 3. Mortality rate was 15.7%, and increased significantly from normal renal function to stage 3 (Normal, 3.5%; stage 1, 9%; stage 2, 33.3%; and stage 3, 59%; P<0.0001). Forward stepwise multivariate regression analysis showed that stage 2 (odds ratio 10.13, 95% confidence interval 1.44–70.89, P=0.02), stage 3 (odds ratio 20.10, 95% confidence interval 3.72–108.4, P<0.0001), as well as the allogeneic HCT (odds ratio 9.25, 95% confidence interval 1.22–69.75, P=0.031) and sepsis (odds ratio 12.27, 95% confidence interval 3.11–48.31, P<0.0001) were associated with increased mortality, while stage 1 (odds ratio 1.32, 95% confidence interval 0.17–9.9, P=0.786) did not. Acute kidney injury defined by AKIN had good discriminative power on the in-hospital mortality rate (area under the receiver operating characteristic curve 0.775±0.051, P<0.0001). In sum, the AKIN criteria enabled us to identify 40% of myeloablative HCT patients with various degrees of acute renal dysfunction, and seem an important tool to stratify these patients according to mortality risk.

Table 1 Classification/staging system for acute kidney injury3 (AKI)
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References

  1. Lopes JA, Jorge S, Silva S, de Almeida E, Abreu F, Martins C et al. An assessment of the RIFLE criteria for acute renal failure following myeloablative autologous and allogeneic haematopoietic cell transplantation. Bone Marrow Transplant 2006; 38: 395.

    Article  CAS  PubMed  Google Scholar 

  2. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky and the ADQI workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204–R212.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al., the Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisboa, Portugal

    J A Lopes, S Jorge, S Silva, E de Almeida, F Abreu & M M Prata

  2. Department of Hematology, Hospital de Santa Maria, Lisboa, Portugal

    C Martins, J Alves do Carmo & J F Lacerda

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  1. J A Lopes
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  2. S Jorge
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  3. S Silva
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Correspondence to J A Lopes.

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Lopes, J., Jorge, S., Silva, S. et al. Prognostic utility of the acute kidney injury network (AKIN) criteria for acute kidney injury in myeloablative haematopoietic cell transplantation. Bone Marrow Transplant 40, 1005–1006 (2007). https://doi.org/10.1038/sj.bmt.1705860

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