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Table 3.

Time (hours) to reach within 0.1 mg/dl of predicted steady-state SCr concentration after a given reduction in CrCl

The differential equation used to describe a one-compartment model of creatinine kinetics can be solved for time (see equation 5, Appendix). The equation was used to examine the time required to reach a given end point in SCr after a given reduction in CrCl. Kate Spade New York Womens Zahara Leather Slide Sandals 2pormVPw7V
shows the time to reach a 50% increase in SCr as a function of percentage reduction in CrCl for varying levels of baseline kidney function, whereas Pieces PSVERA LEAF Pool shoes black 82R9TFybK
shows the same analysis for an absolute 0.5-mg/dl increase in SCr. As seen in Giuseppe Zanotti Tropical Beach Sandals 2h2ldg2
, at any given reduction in CrCl from baseline, the time to reach a 50% increase in SCr is greater for increasing stages of CKD. For example, after complete cessation of CrCl ( e.g. , anuric AKI), SCr increases by 50% after 4 h in the case of no preexisting CKD, whereas it takes 23 h to achieve a 50% increase in SCr for a patient with stage 4 CKD. By contrast, when the criterion is an absolute increase in SCr, the results are very different. As seen in Dr Martens Mens Vibe Dante Brando 6Eye Low Top Shoes UK 11 7CEHeRtg
, the time to reach a 0.5-mg/dl increase in SCr is virtually identical after ≥50% reductions in CrCl irrespective of baseline kidney function. The curves begin to diverge at CrCl reductions <50%; after less severe AKI, such as a 30% reduction in CrCl, a 0.5-mg/dl increase never occurs in the setting of no preexisting CKD and stage 2 CKD, whereas it occurs after 24 h in the setting of stage 4 CKD. By contrast, as shown in Figure 5 , a 50% increase in SCr never occurs at any level of baseline kidney function after a 30% decline in CrCl. Results using the one- or two-compartment model of creatinine kinetics were similar (data not shown).

View larger version:
Figure 5.

Time to reach a 50% increase in SCr after a given percentage reduction in CrCl, according to the absence or presence of stages 2 through 4 CKD 4.

View larger version:
Figure 6.

Time to reach a 0.5-mg/dl increase in SCr after a given percentage reduction in CrCl, according to the absence or presence of stages 2 through 4 CKD.

The CrCl reduction required to account for a given rise in SCr over time t can be calculated (equation 4, Appendix). The equation was used to compare the implications of absolute versus percentage increases in SCr as the definition of AKI. For these analyses, we compared absolute cutoffs of 0.3-, 0.5-, 1.0-, and 1.5-mg/dl increases against the RIFLE criteria ( Table 1 ) at 12, 24, and 48 h. Ideally, a given stage of AKI should denote a similar reduction in CrCl across a range of baseline kidney function. As shown in Maison Martin Margiela Heels bglXF
, this is the case when using absolute increases in SCr to define AKI at early stages after injury. Franco Sarto Kasa Strappy SlipOn Flat Sandals Womens Shoes 3H3pnol
also highlights the importance of considering the time over which SCr rises when inferring the degree of AKI: A patient who has stage 4 CKD and whose SCr increases by 0.3 mg/dl over 12 h has suffered a 33% reduction in CrCl; the same absolute increase over 48 h corresponds to a modest 11% reduction in CrCl (assuming constant generation rate and volume of distribution).

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