The Prognostic Importance of a Small Acute Decrement in Kidney Function in Hospitalized Patients: A Systematic Review and Meta-Analysis
Received 6 March 2007; accepted 18 July 2007. published online 08 October 2007.
Background
Recently, acute kidney injury defined by small changes in serum creatinine levels was associated with worse short-term outcomes; however, the precision and variability of this association was not fully explored.
Study Design
Systematic review and meta-analysis.
Setting & Participants
Hospitalized patients.
Selection Criteria for Studies
MEDLINE and EMBASE databases were searched for observational cohort studies and randomized controlled trials published from 1990 through February 2007 that provided information for small changes in serum creatinine levels.
Predictor
Small acute changes in serum creatinine levels by absolute and percentage of changes in serum creatinine levels (lower threshold for increase in serum creatinine <0.5 mg/dL or <25%).
Outcome
Short-term mortality (≤30 days).
Results
Compared with controls, patients with a 10% to 24% increase in creatinine levels had a relative risk (RR) of death of 1.8 (95% confidence interval [CI], 1.3 to 2.5). By comparison, subjects with a 25% to 49% acute change in creatinine levels had an RR of death of 3.0 (95% CI, 1.6 to 5.8), and those with the largest change (≥50%) had the greatest RR of death (RR, 6.9; 95% CI, 2.0 to 24.5). Results were similar when absolute changes in creatinine levels were considered and when pooled estimates of adjusted RR were used.
Limitations
Individual patient data were unavailable; thus, only group-level data were pooled for meta-analysis. Results showed a significant degree of statistical heterogeneity that was only partially ameliorated by separating studies into subsets based on clinical setting.
Conclusions
Short-term mortality and acute decreases in renal function are associated through a graded relationship such that even mild changes in serum creatinine levels portend worse outcome in a variety of clinical settings and patient-types.
Address correspondence to Chirag R. Parikh, MD, PhD, Section of Nephrology, Yale University and VAMC, Clinical Epidemiology Research Center, 950 Campbell Ave, Mail Code 151B, Bldg 35 A, Rm 219, West Haven, CT 06516.
ABSTRACT