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Available online 25 February 2024
Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis
Excreción fraccional de sodio y potasio, y brecha aniónica urinaria en la evaluación de la IRA persistente en sepsis
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Nicolás Contrera Rolóna,b,
Corresponding author
nicolas.contrerarolon@hospitalitaliano.org.ar

Corresponding author at: Hospital Italiano de Buenos Aires, Tte. Gral. Perón 4190, Ciudad Autónoma de Buenos Aires, C1199ABB, Argentina.
, Joaquín Cantosa, Iván Huespea, Eduardo Pradoa, Griselda I. Brattib, Carlos Schreckb, Sergio Giannasia, Guillermo Rosa Diezb, Carlos F. Varelab
a Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
b Nephrology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Table 1. Baseline characteristics of patients in the study.
Table 2. Clinical and laboratory data of persistent and transient AKI episodes.
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Abstract
Objective

To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock.

Design

Retrospective cohort study.

Setting

Two intensive care units in Argentina.

Patients

Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24h of the AKI diagnosis.

Interventions

None.

Main variables of interest

We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis.

Results

80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC=0.52, p=0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60−0.83; p=0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57−0.80; p=0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%.

Conclusions

urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.

Keywords:
Acute kidney injury
Sepsis
Sepsis-associated AKI
Persistent AKI
Fractional excretion of sodium
Fractional excretion of potassium
Urinary strong ion difference
Abbreviations:
AKI
pAKI
tAKI
S-AKI
ACEI
ARB
ICU
IMV
KDIGO
RRT
Resumen
Objetivo

Evaluar la utilidad diagnóstica de la Excreción fraccional de Sodio (FENa), Excreción fraccional de potasio (FEK) y uSID (diferencia de aniones fuertes urinaria) en el diagnóstico de la IRA persistente (IRAp).

Ámbito

2 unidades de cuidados intensivos en Argentina.

Pacientes

Adultos con diagnóstico de sepsis o shock séptico e injuria renal aguda (IRA) y disponibilidad de una bioquímica urinaria dentro de las 24hs del diagnóstico de la IRA.

Intervención

Ninguna.

Variables de interés principales

Evaluamos la capacidad diagnóstica de la FENa y FEK y la brecha aniónica urinaria mediante un análisis de la curva ROC (Receiver Operating Characteristic).

Resultados

Se incluyeron 40 pacientes en cada grupo (IRAp vs transitoria). Los pacientes con IRAp tuvieron mayor APACHE, SOFA y mortalidad. En el análisis de las curvas ROC, la uSID no demostró utilidad diagnóstica (AUC=0.52). La FENa presentó moderada precisión con un AUC de 0.71 (IC95% 0.60–0.83), mientras que la FEK tuvo un AUC de 0.69 (IC95% 0.57−0.80). El punto de Youden para diferenciar IRAp para la FENa fue de 0.51% con una sensibilidad de 65.0% y una especificidad de 72.5%. En el caso de la FEK, el punto óptimo fue de 21.9% con una sensibilidad de 65.0% y una especificidad de 67.5%.

Conclusiones

La interpretación de la bioquímica urinaria en pacientes sépticos debe ser revisada. La FENa y FEK están relacionados con la severidad de la IRA y pueden ser herramientas diagnósticas complementarias de utilidad.

Palabras clave:
Injuria renal aguda
Sepsis
IRA asociada a la sepsis
IRA persistente
Fracción excretada de sodio
Fracción excretada de potasio
Diferencia de aniones fuertes urinaria

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