A resource of Calculate by QxMD at https://www.qxmd.com/calculate
Over 400 decision support tools available • get the app for iOS or Android at qx.md/calculate
KDIGO Clinical Practice Guideline for Acute Kidney Injury
GFR/SCr algorithm
GFR/SCr algorithm
Figure 7 provides a diagnostic algorithm based on a sequential approach through three questions: i) Is GFR decreased or is SCr increased (according to the criteria in Table 12)?; ii) Is SCr increasing or GFR decreasing (according to the criteria in Table 12)?; and iii) Does the decrease in GFR or increase in SCr resolve within 3 months? Based on a ‘‘yes’’ or ‘‘no’’ response to these three sequential questions, all combinations of AKI, AKD, and CKD can be identified. In this section, we review the algorithm and illustrate its use for classification of patients with acute and chronic kidney disease in two previously reported cohorts.
Table 12 | Examples of AKI, CKD, and AKD based on GFR and increases in SCr
| Baseline GFR (ml/min per 1.73m2) |
Increase in SCr during 7 consecutive days |
GFR during next 3 months |
Diagnosis |
|---|---|---|---|
| > 60 | > 1.5 x | NA | AKI |
| > 60 | < 1.5 x | < 60 | AKD without AKI |
| > 60 | < 1.5 x | > 60 | NKD |
| Baseline GFR (ml/min per 1.73m2) |
Change in SCr during next 7 days |
GFR during next 3 months |
Diagnosis |
| < 60 | > 1.5 x | NA | AKI + CKD |
| < 60 | < 1.5 x | > 35% decrease | AKD without AKI + CKD |
| < 60 | < 1.5 x | < 35% decrease | CKD |
GFR assessed from measured or estimated GFR. Estimated GFR does not reflect measured GFR in AKI as accurately as in CKD.
AKD, acute kidney diseases and disorders; AKI, acute kidney injury; CKD, chronic kidney disease; GFR, glomerular filtration rate; NKD, no known kidney disease; SCr, serum creatinine.
Figure 6 | Chronic Kidney Disease Epidemiology Collaboration cohort changes in eGFR and final eGFR corresponding to KDIGO definition and stages of AKI. Panels (a) and (b) show the final eGFR and the percent changes in eGFR, respectively, corresponding to the KDIGO definition and stages of AKI. The horizontal line in panel a and b indicates the threshold value for AKD (< 60 ml/min per 1.73 m2 and > 35% reduction in initial GFR, respectively). Points above the horizontal line indicate subjects who meet the SCr criteria for the definition of AKI but do not meet eGFR criteria for the definition of AKD. AKD, acute kidney disorder/disease; AKI, acute kidney injury; eGFR, estimated glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes; SCr, serum creatinine. (Lesley Inker, personal communication.)
Figure 7 | GFR/SCr algorithm. See text for description. AKD, acute kidney disease/disorder; AKI, acute kidney injury; CKD, chronic kidney disease; GFR, glomerular filtration rate; NKD, no known kidney disease; SCr, serum creatinine.
The answer to Question 1 requires ascertainment of an index GFR/SCr as well during the prior 3 months. The index GFR/SCr can be assigned as any of the GFR/SCr measures during the interval of observation. The answer classifies patients into three categories: NKD, AKD, and CKD. Question 2 requires repeat ascertainment of kidney function after the index measure. ‘‘No’’ indicates that the increase in SCr or decrease in GFR after the index measure does not meet AKI or AKD criteria; ‘‘Yes-D’’ indicates that increase in SCr and decrease in GFR meets the AKD criteria but not AKI criteria; and ‘‘Yes-I’’ indicates that increase in SCr meets AKI criteria. Question 3 requires repeat ascertainment of GFR/ SCr 3 months after the index measure. ‘‘Yes’’ indicates GFR > 60, indicating NKD. No indicates GFR < 60, and based on prior level of GFR, may indicate stable, new, or worse CKD.
Contact us
Do you have an enquiry or suggestion? Get in touch with us through Twitter @QxMD, Facebook QxMD, or email contact@qxmd.com