Association of oliguria with the development of acute kidney injury in the critically ill

• Published in: Kidney international Vol. 89; no. 1; pp. 200 - 208
• Main Authors: Vaara, Suvi T., Parviainen, Ilkka, Pettilä, Ville, Nisula, Sara, Inkinen, Outi, Uusaro, Ari, Laru-Sompa, Raili, Pulkkinen, Anni, Saarelainen, Minna, Reilama, Mikko, Tolmunen, Sinikka, Rantalainen, Ulla, Suvela, Markku, Pesola, Katrine, Saastamoinen, Pekka, Kaukonen, Kirsi-Maija, Korhonen, Anna-Maija, Vaara, Suvi, Suojaranta-Ylinen, Raili, Mildh, Leena, Haapio, Mikko, Nurminen, Laura, Sutinen, Sari, Pettilä, Leena, Laitinen, Helinä, Syrjä, Heidi, Henttonen, Kirsi, Lappi, Elina, Varpula, Tero, Porkka, Päivi, Sivula, Mirka, Rahkonen, Mira, Tsurkka, Anne, Nieminen, Taina, Alaspää, Ari, Salanto, Ville, Juntunen, Hanna, Ruokonen, Esko, Bendel, Stepani, Rissanen, Niina, Lång, Maarit, Rahikainen, Sari, Rissanen, Saija, Ahonen, Merja, Halonen, Elina, Poukkanen, Meri, Lintula, Esa, Heikkinen, Jorma, Lavander, Timo, Heinonen, Kirsi, Kaminski, Tadeusz, Gäddnäs, Fiia, Kuusela, Tuija, Karlsson, Sari, Reinikainen, Matti, Surakka, Tero, Jyrkönen, Helena, Eiserbeck, Tanja, Ala-Kokko, Tero, Laurila, Jouko, Lund, Vesa, Tuominen, Päivi, Perkola, Pauliina, Tuominen, Riikka, Hietaranta, Marika, Hovilehto, Seppo, Kirsi, Anne, Tiainen, Pekka, Myllärinen, Tuija, Leino, Pirjo, Kuitunen, Anne, Tenhu-nen, Jyrki, Leppänen, Ilona, Levoranta, Markus, Hoppu, Sanna, Sauranen, Jukka, Kukkurainen, Atte, Kortelainen, Samuli, Koivuviita, Niina, Kotamäki, Jutta, Koivisto, Simo-Pekka, Hautamäki, Raku, Skinnar, Maria
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.2015.269

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.