title: New ICA criteria for the diagnosis of acute kidney injury in cirrhotic patients: can we use an imputed value of serum creatinine?
abstract: OBJECTIVE
  The new International Club of Ascites diagnostic criteria to diagnose acute kidney injury at hospital admission suggests the possibility of using a presumed baseline serum creatinine, defined as the last of at least two stable creatinine values during the last 3 months. Nevertheless, the possibility of the lack of such a value still remains. In these patients, the KDIGO criteria suggest to use an inverse application of MDRD equation assuming that baseline glomerular filtration rate is 75 ml/min per 1.73 m(2) (imputed baseline creatinine). We tested the accuracy of this approach to detect acute kidney injury at admission in patients with decompensated cirrhosis and creatinine <1.5 mg/dl.
  
  
  METHODS
  We analysed 213 patients hospitalized for acute decompensation of cirrhosis. At admission, glomerular filtration rate was estimated using creatinine-based equations and measured by inulin clearance. A diagnosis of acute kidney injury was made using an imputed value of serum creatinine as baseline.
  
  
  RESULTS
  The diagnosis of AKI based on an imputed baseline creatinine identified only 20.1% of patients with measured glomerular filtration rate ≤60 ml/min/1.73 m(2) without any predictive value on 90-day survival.
  
  
  CONCLUSIONS
  In patients with cirrhosis and ascites with a creatinine <1.5 mg/dl without a baseline value on their records, the diagnosis of acute kidney injury at admission based on an imputed baseline creatinine is not accurate.
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rosi
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Cavallin
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gola
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Romano
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Montagnese
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Sticca
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.affiliation: Department of Medicine (DIMED), University of Padova, Padova, Italy.|Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis*; D000368:Aged; D001201:Ascites / Q000175:diagnosis*; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D015996:Survival Rate
chemical_list: D003404:Creatinine
keywords: acute kidney injury; cirrhosis; creatinine; glomerular filtration rate; renal failure