Kidney Disease Improving Global Outcomes (KDIGO) guidelines address the definition, classification, and management of acute kidney injury (AKI) and chronic kidney disease (CKD).
The KDIGO guidelines define AKI as follows:
- Increase in serum creatinine by ≥0.3 mg/dL (≥26.5 micromol/L) within 48 hours, or
- Increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior seven days, or
- Urine volume <0.5 mL/kg/hour for six hours
The KDIGO criteria allow for correction of volume status and obstructive causes of AKI prior to classification. Before diagnosing and classifying AKI, one should assess and optimize volume status and exclude obstruction. This is based upon AKIN criteria, on which the KDIGO definition is based. The AKIN state that these criteria should be used in the context of the clinical presentation and following adequate fluid resuscitation, when applicable, and that use of the urine output criteria alone requires exclusion of urinary tract obstruction or other easily reversible causes of reduced urine output.
Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, AKI is staged as follows:
- Stage 1: Increase in serum creatinine to 1.5 to 1.9 times baseline, or increase in serum creatinine by ≥0.3 mg/dL (≥26.5 micromol/L), or reduction in urine output to <0.5 mL/kg/hour for 6 to 12 hours.
- Stage 2: Increase in serum creatinine to 2.0 to 2.9 times baseline, or reduction in urine output to <0.5 mL/kg/hour for ≥12 hours.
- Stage 3: Increase in serum creatinine to 3.0 times baseline, or increase in serum creatinine to ≥4.0 mg/dL (≥353.6 micromol/L), or reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or anuria for ≥12 hours, or the initiation of kidney replacement therapy, or, in patients <18 years, decrease in estimated glomerular filtration rate (eGFR) to <35 mL/min/1.73 m2.
The KDIGO criteria differ from the RIFLE classification in that the KDIGO criteria only utilize changes in serum creatinine and urine output, not changes in GFR for staging, with the exception of children under the age of 18 years, for whom an acute decrease in eGFR to <35 mL/min/1.73 m2 is included in the criteria for stage 3 AKI.
References:
- Levey AS. Defining AKD: The Spectrum of AKI, AKD, and CKD. Nephron. 2021 Jun 24:1-4. [Medline]
- Kellum JA. Diagnostic Criteria for Acute Kidney Injury: Present and Future. Crit Care Clin. 2015 Oct;31(4):621-32. [Medline]
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. [Medline]
Created Jul 29, 2021.
Update Aug 12, 2024.
