Key result
Acute kidney injury diagnosed by KDIGO criteria was detected in 36.6% of myocardial infarction patients and was associated with a significantly increased risk of 30-day mortality (HR 3.99).
Why the study?
Does the KDIGO criteria for acute kidney injury better predict mortality compared to RIFLE criteria in patients with acute myocardial infarction?
Cohort (n=1,050)
No
Does the KDIGO criteria for acute kidney injury better predict mortality compared to RIFLE criteria in patients with acute myocardial infarction?
Hazard Ratio: 3.99 (95% CI 2.59–6.15)
Absolute Event Rate: 26% vs 4.7%
p-value: p=<0.001
The KDIGO criteria detect substantially more cases of acute kidney injury in patients with acute myocardial infarction compared to RIFLE criteria, identifying a subgroup with significantly higher early and late mortality.
AKI by KDIGO criteria flags high short-term mortality risk in MI; hypothesis-generating for superiority over RIFLE in risk stratification.
BACKGROUND: Acute kidney injury (AKI) increases the risk of death after acute myocardial infarction (AMI). Recently, a new AKI definition was proposed by the Kidney Disease Improving Global Outcomes (KDIGO) organization. The aim of the current study was to compare the incidence and the early and late mortality of AKI diagnosed by RIFLE and KDIGO criteria in the first 7 days of hospitalization due to an AMI. METHODS AND RESULTS: In total, 1,050 AMI patients were prospectively studied. AKI defined by RIFLE and KDIGO occurred in 14.8% and 36.6% of patients, respectively. By applying multivariate Cox analysis, AKI was associated with an increased adjusted hazard ratio (AHR) for 30-day death of 3.51 (95% confidence interval [CI] 2.35-5.25, p<0.001) by RIFLE and 3.99 (CI 2.59-6.15, p<0.001) by KDIGO and with an AHR for 1-year mortality of 1.84 (CI 1.12-3.01, p=0.016) by RIFLE and 2.43 (CI 1.62-3.62, p<0.001) by KDIGO. The subgroup of patients diagnosed as non-AKI by RIFLE but as AKI by KDIGO criteria had also an increased AHR for death of 2.55 (1.52-4.28) at 30 days and 2.28 (CI 1.46-3.54) at 1 year (p<0.001). CONCLUSIONS: KDIGO criteria detected substantially more AKI patients than RIFLE among AMI patients. Patients diagnosed as AKI by KDIGO but not RIFLE criteria had a significantly higher early and late mortality. In this study KDIGO criteria were more suitable for AKI diagnosis in AMI patients than RIFLE criteria.
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Rodrigues et al. (2013) conducted a cohort in Acute Myocardial Infarction (n=1,050). Acute kidney injury (KDIGO criteria) vs. No acute kidney injury was evaluated on 30-day all-cause mortality (HR 3.99, 95% CI 2.59-6.15, p=<0.001). Acute kidney injury diagnosed by KDIGO criteria was detected in 36.6% of myocardial infarction patients and was associated with a significantly increased risk of 30-day mortality (HR 3.99).
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