The inconsistencies in classifying AKI according to the KDIGO (Kidney Disease: Improving Global Outcomes) urine output (UO) criteria have prevented an accurate assessment of the role this easily available biomarker can play in the early identification of AKI. Study goal: To assess and compare the performance of the two KDIGO criteria (SCr and UO) for early identification of AKI in the intensive care unit (ICU) by comparing the standard SCr criteria to real-time, consecutive, electronic urine output measurements.
95 catheterized patients in the GICU of Hadassah Medical Center, Israel were connected to The RenalSense™ Clarity RMS™ sensor kit to monitor UO electronically (UOelec). UOelec and SCr were recorded between 24-48 hours and up to one week, respectively, after ICU admission.
Real-time consecutive UO measurements identified significantly more AKI patients than SCr in the patient population, 57.9% (N=55) versus 26.4% (N=25), respectively (P<0.0001). In 20 patients that had AKI according to both criteria, time to AKI identification was significantly earlier by the UOelec criteria as compared to the SCr criteria (P<0.0001). Among this population, the median (IQR) identification time of AKI UOelec was 12.75 (8.75, 26.25) hours from ICU admission and 39.06 (25.8, 108.64) hours for AKI SCr.
Application of KDIGO criteria for AKI using continuous electronic monitoring of UO identifies more AKI patients, and identifies them earlier, than using the SCr criteria alone. This application can enable the clinician to set protocol goals for earlier intervention of the treatment of AKI.