title: Identification and predicting short-term prognosis of early cardiorenal syndrome type 1: KDIGO is superior to RIFLE or AKIN.
abstract: OBJECTIVE
  Acute kidney injury (AKI) in patients hospitalized for acute heart failure (AHF) is usually type 1 of the cardiorenal syndrome (CRS) and has been associated with increased morbidity and mortality. Early recognition of AKI is critical. This study was to determine if the new KDIGO criteria (Kidney Disease: Improving Global Outcomes) for identification and short-term prognosis of early CRS type 1 was superior to the previous RIFLE and AKIN criteria.
  
  
  METHODS
  The association between AKI diagnosed by KDIGO but not by RIFLE or AKIN and in-hospital mortality was retrospectively evaluated in 1005 Chinese adult patients with AHF between July 2008 and May 2012. AKI was defined as RIFLE, AKIN and KDIGO criteria, respectively. Cox regression was used for multivariate analysis of in-hospital mortality.
  
  
  RESULTS
  Within 7 days on admission, the incidence of CRS type 1 was 38.9% by KDIGO criteria, 34.7% by AKIN, and 32.1% by RIFLE. A total of 110 (10.9%) cases were additional diagnosed by KDIGO criteria but not by RIFLE or AKIN. 89.1% of them were in Stage 1 (AKIN) or Stage Risk (RIFLE). They accounted for 18.4% (25 cases) of the overall death. After adjustment, this proportion remained an independent risk factor for in-hospital mortality [odds ratios (OR)3.24, 95% confidence interval(95%CI) 1.97-5.35]. Kaplan-Meier curve showed AKI patients by RIFLE, AKIN, KDIGO and [K(+)R(-)+K(+)A(-)] had lower hospital survival than non-AKI patients (Log Rank P<0.001).
  
  
  CONCLUSIONS
  KDIGO criteria identified significantly more CRS type 1 episodes than RIFLE or AKIN. AKI missed diagnosed by RIFLE or AKIN criteria was an independent risk factor for in-hospital mortality, indicating the new KDIGO criteria was superior to RIFLE and AKIN in predicting short-term outcomes in early CRS type 1.
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Zhilian
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Nephrology, Huzhou Central Hospital, Huzhou, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Cai
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Southern Medical University, Guangzhou, China.
authors.forename: Xinling
authors.initials: X
authors.lastname: Liang
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Zhiming
authors.initials: Z
authors.lastname: Du
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Yuanhan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Bio-Statistics, Southern Medical University, Guangzhou, China.
authors.forename: Shengli
authors.initials: S
authors.lastname: An
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Tan
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Ruizhao
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou, China.
authors.forename: Liwen
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059347:Cardio-Renal Syndrome / Q000175:diagnosis* / Q000401:mortality*; D042241:Early Diagnosis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors