Mohammad Abdelhafez1, Tarek Nayfeh2,3, Anwar Atieh1, Omar AbuShamma1, Basheer Babaa1, Muath Baniowda1, Alaa Hrizat1, Bashar Hasan2,3, Leslie Hassett4, Abdurrahman Hamadah5, Kamel Gharaibeh6,7. 1. Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine. 2. Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota. 3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. 4. Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota. 5. Section of Nephrology, St. Luke's Hospital, Duluth, Minnesota. 6. Department of Internal Medicine, Al-Quds University, Jerusalem, State of Palestine kamelgharaibeh@gmail.com. 7. Division of Pulmonary & Critical Care, University of Maryland, Baltimore, Maryland.
Abstract
BACKGROUND AND OBJECTIVES: AKI is classified as prerenal, intrinsic, and postrenal. Prerenal AKI and intrinsic AKI represent the most common causes for AKI in hospitalized patients. This study aimed to examine the accuracy of the fractional excretion of sodium for distinguishing intrinsic from prerenal AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, the Cochrane Library, and Scopus for all available studies that met the criteria until December 31, 2021. We included studies that evaluated fractional excretion of sodium in differentiating AKI etiologies in adults, whereas studies that did not have sufficient data to extract a 2×2 table were excluded. We assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and extracted the diagnostic accuracy data for all included studies. We conducted a meta-analysis using the bivariate random effects model. We performed subgroup analysis to investigate sources of heterogeneity and the effect of the relevant confounders on fractional excretion of sodium accuracy. RESULTS: We included 19 studies with 1287 patients. In a subset of 15 studies (872 patients) that used a threshold of 1%, the pooled sensitivity and specificity for differentiating intrinsic from prerenal AKI were 90% (95% confidence interval, 81% to 95%) and 82% (95% confidence interval, 70% to 90%), respectively. In a subgroup of six studies (511 patients) that included CKD or patients on diuretics, the pooled sensitivity and specificity were 83% (95% confidence interval, 64% to 93%) and 66% (95% confidence interval, 51% to 78%), respectively. In five studies with 238 patients on diuretics, the pooled sensitivity and specificity were 80% (95% confidence interval, 69% to 87%) and 54% (95% confidence interval, 31% to 75%), respectively. In eight studies with 264 oliguric patients with no history of CKD or diuretic therapy, the pooled sensitivity and specificity were 95% (95% confidence interval, 82% to 99%) and 91% (95% confidence interval, 83% to 95%), respectively. CONCLUSIONS: Fractional excretion of sodium has a limited role for AKI differentiation in patients with a history of CKD or those on diuretic therapy. It is most valuable when oliguria is present.
BACKGROUND AND OBJECTIVES: AKI is classified as prerenal, intrinsic, and postrenal. Prerenal AKI and intrinsic AKI represent the most common causes for AKI in hospitalized patients. This study aimed to examine the accuracy of the fractional excretion of sodium for distinguishing intrinsic from prerenal AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, the Cochrane Library, and Scopus for all available studies that met the criteria until December 31, 2021. We included studies that evaluated fractional excretion of sodium in differentiating AKI etiologies in adults, whereas studies that did not have sufficient data to extract a 2×2 table were excluded. We assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and extracted the diagnostic accuracy data for all included studies. We conducted a meta-analysis using the bivariate random effects model. We performed subgroup analysis to investigate sources of heterogeneity and the effect of the relevant confounders on fractional excretion of sodium accuracy. RESULTS: We included 19 studies with 1287 patients. In a subset of 15 studies (872 patients) that used a threshold of 1%, the pooled sensitivity and specificity for differentiating intrinsic from prerenal AKI were 90% (95% confidence interval, 81% to 95%) and 82% (95% confidence interval, 70% to 90%), respectively. In a subgroup of six studies (511 patients) that included CKD or patients on diuretics, the pooled sensitivity and specificity were 83% (95% confidence interval, 64% to 93%) and 66% (95% confidence interval, 51% to 78%), respectively. In five studies with 238 patients on diuretics, the pooled sensitivity and specificity were 80% (95% confidence interval, 69% to 87%) and 54% (95% confidence interval, 31% to 75%), respectively. In eight studies with 264 oliguric patients with no history of CKD or diuretic therapy, the pooled sensitivity and specificity were 95% (95% confidence interval, 82% to 99%) and 91% (95% confidence interval, 83% to 95%), respectively. CONCLUSIONS: Fractional excretion of sodium has a limited role for AKI differentiation in patients with a history of CKD or those on diuretic therapy. It is most valuable when oliguria is present.
Authors: Paolo Angeli; Pere Ginès; Florence Wong; Mauro Bernardi; Thomas D Boyer; Alexander Gerbes; Richard Moreau; Rajiv Jalan; Shiv K Sarin; Salvatore Piano; Kevin Moore; Samuel S Lee; Francois Durand; Francesco Salerno; Paolo Caraceni; W Ray Kim; Vicente Arroyo; Guadalupe Garcia-Tsao Journal: J Hepatol Date: 2015-01-28 Impact factor: 25.083
Authors: T R Miller; R J Anderson; S L Linas; W L Henrich; A S Berns; P A Gabow; R W Schrier Journal: Ann Intern Med Date: 1978-07 Impact factor: 25.391
Authors: V Arroyo; P Ginès; A L Gerbes; F J Dudley; P Gentilini; G Laffi; T B Reynolds; H Ring-Larsen; J Schölmerich Journal: Hepatology Date: 1996-01 Impact factor: 17.425