Body weight definitions for evaluating a urinary diagnosis of acute kidney injury in patients with sepsis View Full Text


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Article Info

DATE

2018-12

AUTHORS

Shinshu Katayama, Kansuke Koyama, Yuya Goto, Toshitaka Koinuma, Ken Tonai, Jun Shima, Masahiko Wada, Shin Nunomiya

ABSTRACT

BACKGROUND: We hypothesized that the use of actual body weight might lead to more frequent misdiagnosis of acute kidney injury (AKI) than when ideal body weight is used in underweight and/or obese patients. We examined which definition of body weight is most effective in establishing a urinary diagnosis of AKI in septic patients. METHODS: Consecutive patients aged ≥ 20 years admitted to the intensive care unit of a university hospital between June 2011 and December 2016 were analyzed. Sepsis was defined in accordance with the Sepsis-3 criteria. AKI was defined as a urinary output of < 0.5 mL/kg/6h during intensive care unit stay. Patients were divided into one of four body mass index-based classes. The severity of illness and 90-day mortality were compared across the body mass index subgroups in patients diagnosed using the actual body weight or ideal body weight. RESULTS: Of 5764 patients, 569 septic patients were analyzed. One hundred and fifty-three (26.9%) and 140 (24.6%) patients were diagnosed as having AKI using actual body weight and ideal body weight, respectively. There were no significant differences in the severity of illness among these groups. Also, 90-day mortality did not differ significantly among these groups. According to body mass index, 90-day mortality significantly differed in patients diagnosed using their actual body weights (underweight vs. normal vs. overweight vs. obese: 76.7% vs. 39.5% vs. 26.0% vs. 35.7%, P = 0.033). CONCLUSION: Generally, using actual body weight to calculate the weight-adjusted hourly urine output for diagnosing AKI increased the sensitivity compared to ideal body weight, irrespective of the severity of illness in septic patients. Delayed diagnosis, however, was more common among underweight patients in this situation, and clinicians should be cautious when diagnosing urinary AKI using actual body weight. More... »

PAGES

101

References to SciGraph publications

  • 2008-02. Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme Database in CRITICAL CARE
  • 2013-02. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1) in CRITICAL CARE
  • 2011-10. Oliguria is an early predictor of higher mortality in critically ill patients in KIDNEY INTERNATIONAL
  • 2017-12. Predictive value of serum cystatin C for acute kidney injury in adults: a meta-analysis of prospective cohort trials in SCIENTIFIC REPORTS
  • 1996-07. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure in INTENSIVE CARE MEDICINE
  • 2004-01. Dosing of medications in morbidly obese patients in the intensive care unit setting in INTENSIVE CARE MEDICINE
  • 2011-08. Oliguria as predictive biomarker of acute kidney injury in critically ill patients in CRITICAL CARE
  • 2014-12. Actual versus ideal body weight for acute kidney injury diagnosis and classification in critically Ill patients in BMC NEPHROLOGY
  • 2012-10. A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients in CRITICAL CARE
  • 2008-04. Early acute kidney injury and sepsis: a multicentre evaluation in CRITICAL CARE
  • 2012-12. Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients in CRITICAL CARE
  • Journal

    TITLE

    BMC Nephrology

    ISSUE

    1

    VOLUME

    19

    Author Affiliations

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s12882-018-0895-4

    DOI

    http://dx.doi.org/10.1186/s12882-018-0895-4

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1103738757

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29716530


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        "description": "BACKGROUND: We hypothesized that the use of actual body weight might lead to more frequent misdiagnosis of acute kidney injury (AKI) than when ideal body weight is used in underweight and/or obese patients. We examined which definition of body weight is most effective in establishing a urinary diagnosis of AKI in septic patients.\nMETHODS: Consecutive patients aged \u2265\u00a020\u00a0years admitted to the intensive care unit of a university hospital between June 2011 and December 2016 were analyzed. Sepsis was defined in accordance with the Sepsis-3 criteria. AKI was defined as a urinary output of <\u20090.5\u00a0mL/kg/6h during intensive care unit stay. Patients were divided into one of four body mass index-based classes. The severity of illness and 90-day mortality were compared across the body mass index subgroups in patients diagnosed using the actual body weight or ideal body weight.\nRESULTS: Of 5764 patients, 569 septic patients were analyzed. One hundred and fifty-three (26.9%) and 140 (24.6%) patients were diagnosed as having AKI using actual body weight and ideal body weight, respectively. There were no significant differences in the severity of illness among these groups. Also, 90-day mortality did not differ significantly among these groups. According to body mass index, 90-day mortality significantly differed in patients diagnosed using their actual body weights (underweight vs. normal vs. overweight vs. obese: 76.7% vs. 39.5% vs. 26.0% vs. 35.7%, P\u2009=\u20090.033).\nCONCLUSION: Generally, using actual body weight to calculate the weight-adjusted hourly urine output for diagnosing AKI increased the sensitivity compared to ideal body weight, irrespective of the severity of illness in septic patients. Delayed diagnosis, however, was more common among underweight patients in this situation, and clinicians should be cautious when diagnosing urinary AKI using actual body weight.", 
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    35 schema:description BACKGROUND: We hypothesized that the use of actual body weight might lead to more frequent misdiagnosis of acute kidney injury (AKI) than when ideal body weight is used in underweight and/or obese patients. We examined which definition of body weight is most effective in establishing a urinary diagnosis of AKI in septic patients. METHODS: Consecutive patients aged ≥ 20 years admitted to the intensive care unit of a university hospital between June 2011 and December 2016 were analyzed. Sepsis was defined in accordance with the Sepsis-3 criteria. AKI was defined as a urinary output of < 0.5 mL/kg/6h during intensive care unit stay. Patients were divided into one of four body mass index-based classes. The severity of illness and 90-day mortality were compared across the body mass index subgroups in patients diagnosed using the actual body weight or ideal body weight. RESULTS: Of 5764 patients, 569 septic patients were analyzed. One hundred and fifty-three (26.9%) and 140 (24.6%) patients were diagnosed as having AKI using actual body weight and ideal body weight, respectively. There were no significant differences in the severity of illness among these groups. Also, 90-day mortality did not differ significantly among these groups. According to body mass index, 90-day mortality significantly differed in patients diagnosed using their actual body weights (underweight vs. normal vs. overweight vs. obese: 76.7% vs. 39.5% vs. 26.0% vs. 35.7%, P = 0.033). CONCLUSION: Generally, using actual body weight to calculate the weight-adjusted hourly urine output for diagnosing AKI increased the sensitivity compared to ideal body weight, irrespective of the severity of illness in septic patients. Delayed diagnosis, however, was more common among underweight patients in this situation, and clinicians should be cautious when diagnosing urinary AKI using actual body weight.
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