Association of oliguria with the development of acute kidney injury in the critically ill.
Urine output (UO) criterion may increase the sensitivity of the definition of acute kidney injury (AKI). We determined whether the empirically derived definition for oliguria (<0.5 ml/kg/h) is independently associated with adverse outcome. Data analysis included hourly recorded UO from the prospective, multicenter FINNAKI study conducted in 16 Finnish intensive care units. Confounder-adjusted association of oliguria of different severity and duration primarily with the development of AKI defined by creatinine criterion (Cr-AKI) or renal replacement therapy (RRT) was assessed. Secondarily, we determined the association of oliguria with 90-day mortality. Of the 1966 patients analyzed for the development of AKI, 454 (23.1%) reached this endpoint. Within this AKI cohort, 312 (68.7%) developed Cr-AKI, 21 (4.6%) commenced RRT without Cr-AKI, and 121 (26.7%) commenced RRT with Cr-AKI. Episodes of severe oliguria (<0.1 ml/kg/h) for more than 3 h were independently associated with the development of Cr-AKI or RRT. The shortest periods of consecutive oliguria independently associated with an increased risk for 90-day mortality were 6-12 h of oliguria from 0.3 to <0.5 ml/kg/h, over 6 h of oliguria from 0.1 to <0.3 ml/kg/h, and severe oliguria lasting over 3 h. Thus, our findings underlie the importance of hourly UO measurements.Kidney International advance online publication, 9 September 2015; doi:10.1038/ki.2015.269.
Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Suvi T
ST
Vaara
Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland.
Ilkka
I
Parviainen
Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Ville
V
Pettilä
Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Sara
S
Nisula
Department of Intensive Care, Turku University Hospital, Turku, Finland.
Outi
O
Inkinen
Division of Intensive Care, Kuopio University Hospital, Kuopio, Finland.
Ari
A
Uusaro