Laboratory diagnostic of acute kidney injury and its progression: risk of underdiagnosis in female and elderly patients

Abstract

AbstractObjectiveAcute kidney injury (AKI) is a common disease, with high morbidity and mortality rates. In this study, we investigate the potential influence of sex and age on laboratory diagnostic and outcome. It is known that serum creatinine (SCr) has limitations as a laboratory diagnostic parameter for AKI due to its dependence on muscle mass, which may lead to incorrect or delayed diagnosis for certain patient groups, such as women and the elderly.MethodsOverall, 7592 cases with AKI, hospitalized at the University of Leipzig Medical Center (ULMC) between 1st January 2017 and 31st December 2019, were retrospectively analyzed. Diagnosis and staging of AKI was performed according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, based on the level and dynamics of SCr. The impact of sex and age was analyzed by the recalculation of a female to male and an old to young SCr using the CKD-EPI equation.ResultsThe incidence proportion of AKI in our study cohort was 12.0%, with progressive AKI occurring in 19.2% of these cases (n = 1458). Male cases with AKI were overrepresented (59.6%), with a significantly higher first (+3.5 ml/min) and last eGFR (+2.7 ml/min) (p < 0.001). The highest incidence proportion of AKI was found in the [61–81) age group in female (49.5%) and male (52.7%) cases. Males with progressive AKI were overrepresented (p = 0.04). By defining and staging AKI on the basis of relative and absolute changes in SCr level, it is more difficult for patients with low muscle mass and thus a lower baseline SCr to be diagnosed by an absolute SCr increase. AKIN1 and AKIN3 can be diagnosed by a relative or absolute change in SCr. In females, both stages were less frequently detected by an absolute criterion alone (AKIN1 ♀ 20.2%, ♂ 29.5%, p < 0.001; AKIN3 ♀ 13.4%, ♂ 15.2%, p < 0.001). A recalculated SCr for females (to males) and males (to young males) displayed the expected increase in AKI occurrence and severity with age and in general in females.ConclusionOur study illustrates how SCr as the sole parameter for diagnosis and staging of AKI bears the risk of underdiagnosis of patient groups with low muscle mass, such as women and the elderly. A sex- and age-adapted approach might offer advantages.