Kidney Week

Abstract: FR-PO086

Evaluation of Risk Stratification for AKI: A Comparative Analysis of EKFC, 2009, and 2021 CKD-EPI Glomerular Filtration Estimating Equations

Session Information

• AKI: Epidemiology, Risk Factors, Prevention - I
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Cho, Jeongmin, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Jeongmin Cho,

• Koh, Jung Hun, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Jung Hun Koh,

• Kim, Yaerim, Keimyung University Daegu Dongsan Hospital, Daegu, Korea (the Republic of)

Yaerim Kim,

• Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Dong Ki Kim,

• Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Sehoon Park,

Background

The adoption of the 2021 CKD-EPIcr equation for glomerular filtration rate (GFR) estimation provided race-free eGFR calculation. We aimed to evaluate the differences in acute kidney injury (AKI) risk discrimination power according to 2009 and 2021 CKD-EPIcr, and EKFC equations.

Methods

We performed a retrospective observational study within a tertiary hospital from 2011 to 2021. AKI was defined according to KDIGO serum creatinine criteria. GFR estimates were calculated by three GFR estimating equations: 2009 and 2021 CKD-EPIcr, and EKFC. AKI risk discriminative performances were evaluated with area under receiver operator curves (AUROC) and net reclassification improvement.

Results

A total of 187,139 individuals, including 27,447 (14.7%) of AKI and 159,692 (85.3%) of control, were enrolled. In multivariable regression prediction model, 2009 CKD-EPIcr model (0.7583 [0.755 – 0.7617]) showed superior performance in AKI prediction than 2021 CKD-EPIcr (0.7564 [0.7531 – 0.7597], <0.001) or EKFC model in AUROC (0.7577 [0.7543 – 0.761], <0.001). In reclassification of AKI, 2021 CKD-EPIcr and EKFC models showed a worse classification performance than 2009 CKD-EPIcr model. (-7.24 [-8.21 – -6.21], -2.38 [-2.72 – -1.97] %).

Conclusion

Regarding AKI risk stratification, the 2009 CKD-EPIcr equation showed better discriminative performances compared to 2021 CKD-EPIcr equation.

Figure 1. Performance of GFR estimating equations in classifying AKI using Multivariable ROC-AUC

Figure 2. Net reclassification improvement for AKI (multivariable-model 2)