Department of Nephrology, Prince of Wales Hospital, Randwick, New South Wales, Australia.
University of New South Wales, Kensington, New South Wales, Australia.
Nephrology (Carlton). 2021 Oct;26(10):782-789. doi: 10.1111/nep.13918. Epub 2021 Jul 20.
Kinetic estimated Glomerular Filtration Rate (KeGFR) approximates GFR under non-steady-state conditions. We investigated whether the ratio of KeGFR difference to baseline eGFR could predict acute kidney injury (AKI) earlier than a creatinine-based algorithm that triggered an AKI electronic Alert (eAlert).
This retrospective, single-centre, proof-of-concept cohort study assessed all patients diagnosed with AKI by an automated serum creatinine-based eAlert. The kinetic eGFR, the kinetic eGFR difference from baseline and the ratio of difference to baseline was calculated in subjects with at least two serum creatinine (sCr) measurements within 72 h of AKI.
Patients in the AKI cohort (n = 140) had a significant decline in KeGFR ratio (AKI: 17% IQR 7% to 29%, Non-AKI: 0 IQR -12% to 9%; P-value <.0001). A decrease of the ratio greater than 10% predicted AKI with a sensitivity of 66%, a specificity of 77%, a positive predictive value of 63%, and negative predictive value of 80%. The median lead time between KeGFR ratio decrease and AKI was 24 h (IQR: 19-27 h).
KeGFR ratio is a cheap, simple method that predicted AKI 24 h before laboratory detection. KeGFR may facilitate triaging patients to increased monitoring or intervention.
动力学估计肾小球滤过率（KeGFR）在非稳态条件下近似于 GFR。我们研究了 KeGFR 差值与基线 eGFR 的比值是否比基于肌酐的算法更早预测急性肾损伤（AKI），该算法触发了 AKI 电子警报（eAlert）。
这项回顾性、单中心、概念验证队列研究评估了所有通过基于自动血清肌酐的 eAlert 诊断为 AKI 的患者。在 AKI 发生后 72 小时内至少有两次血清肌酐（sCr）测量的患者中，计算了动力学 eGFR、与基线的动力学 eGFR 差值和差值与基线的比值。
AKI 组患者（n=140）的 KeGFR 比值显著下降（AKI：17% IQR 7%至 29%，非 AKI：0 IQR -12%至 9%；P 值<0.0001）。比值下降超过 10%预测 AKI 的灵敏度为 66%，特异性为 77%，阳性预测值为 63%，阴性预测值为 80%。KeGFR 比值下降与 AKI 之间的中位数领先时间为 24 小时（IQR：19-27 小时）。
KeGFR 比值是一种廉价、简单的方法，可在实验室检测前 24 小时预测 AKI。KeGFR 可能有助于对患者进行分诊，以增加监测或干预。
