Comparing RIFLE, AKIN and KDIGO diagnostic criteria for acute renal injury incidence in patients undergoing major non vascular abdominal surgeries

• Grant number: 16/19319-5
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: October 01, 2016
• End date: September 30, 2017
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Emmanuel de Almeida Burdmann
• Grantee: Marcella Bianco Ermini
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated research grant: 14/19286-4 - Individuals with high risk for acute kidney injury development in clinical relevant situations: a prospective study on epidemiological, diagnostic and prognostic aspects, AP.TEM

Abstract

Acute kidney injury (AKI), a frequent complication in hospitalized patients, is a complex syndrome occurring in many clinical situations, which can be manifested from mild increases serum creatinine (SCr) to anuric kidney failure. In intensive care units (ICU) patients its frequency can reach up to 50%. It has been difficult to do comparisons among different studies and to generalize its results due to the large number of different definitions that have been used for AKI diagnosis. Therefore, new diagnosis criteria were proposed aiming to standardize AKI diagnosis, and two new definitions were developed, RIFLE (Risk, Injury, Failure, Loss and End-Stage Kidney Disease) and AKIN (Acute Kidney Injury Network). Both definitions use small and abrupt increase in SCr and urinary output decrease for AKI diagnosis. The recently launched AKI Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines proposed a new criterion, aiming to harmonize the two previous definitions. According to KDIGO, AKI is defined as an increase of SCr e 0.3 mg/dL within 48 hours, or a SCr increase e 50% from baseline, which is known or presumed to have occurred within the prior 7 days, or urine volume < 0.5 mL/kg/h for 6 hours. We propose an exploratory study aimed to determine the differences in the incidence of AKI defined by the RIFLE criteria diagnoses, and AKIN, KDIGO in patients undergoing major, elective, abdominal, non-vascular surgeries. It will be a prospective, exploratory, quantitative field research study, to be performed in 1,000 patients e 18 years old, who were submitted to major, elective, abdominal, non-vascular surgeries, and who had their pos-op in two surgical ICUs for adults at the Hospital das Clínicas da Faculdade de Medicina da USP. These patients will be studied throughout the first seven days of ICU hospitalization (or until discharge, if it happens before seven days). SCr will be assessed at the pre-op time, at ICU admission, and daily for seven days after ICU admission, or up to discharge (if occurs before seven days). Patients with previous diagnosis of chronic kidney disease stages IV or V, patients who had used nephrotoxic drugs before the surgery, patients with ICU stay less than 48 hours with diagnosis of sepsis during ICU stay will be excluded. The project was approved by the Ethical Committee of the Hospital das Clínicas da Faculdade de Medicina da USP. Patients have to sign Free Informed Consent before entering the study. (AU)