Objective: To determine the discriminatory ability of kinetic glomerular filtration rate (kGFR) to detect acute kidney injury (AKI) when compared with established GFR equations and criteria and relating it to mortality, renal replacement therapy initiation and renal recovery.

Methods: This was a retrospective analysis using data from chart review of 109 intensive care unit (ICU) patients at the University of Santo Tomas Hospital (USTH). The renal function estimates using Chronic Kidney Disease Epidemiology Collaboration (CKDEpi), modification of diet in renal disease (MDRD), Kidney Disease Improving Global Outcomes Acute Kidney Injury (KDIGO AKI), as well as kinetic GFR equations were compared and correlated with renal and cardiovascular outcomes.

Results: The renal function assessed by kGFR, CKD-Epi, MDRD and KDIGO staging based on serum creatinine (SCr) showed no significant association with mortality outcomes. However, AKI diagnosed based on urine output (UO), and combined SCr and urine output (KDIGO) showed association with all-cause mortality. The UO detected severe stages of AKI while SCr (based on KDIGO) better identified the earlier stages of AKI. The criteria for KDIGO AKI when combined also shows mortality prediction since it joins together the effects of SCr and UO. There was a remarkable 3.5 times increase in hemodialysis initiation (p=0.0001) and 12.89 times increase in peritoneal dialysis initiation (p=0.01) for every stage increase in the KDIGO classification. kGFR, CKD-Epi and MDRD have 5%, 6%, and 6% decrease, respectively in the odds of initiating hemodialysis. There was however, no association for peritoneal dialysis.

Conclusion: kGFR was the least able in detecting AKI and KDIGO AKI criteria remains to be the standard in identifying AKI in the critical care setting. Increase in SCr was a sensitive tool in diagnosing AKI due to its ability to detect AKI based on a small increase in SCr regardless of the baseline renal function. Decreasing UO, however, is the prognosticating variable in KDIGO AKI criteria, in that it portends higher probability of initiation of renal replacement therapy (RRT) and ultimately higher mortality when present.

Glomerular Filtration Rate ; Critical Illness ; Acute Kidney Injury

This is a case report of a 22-year-old Filipino male, morbidly obese, not known to have diabetes mellitus (DM) who presented with diabetic ketoacidosis on initial diagnosis. He had a phenotype of type 2 DM (T2D) but an initial presentation consistent with type 1 DM (T1D). Insulin therapy was eventually discontinued but he maintained good glycemic control with diet alone. C-peptide showed adequate increase after a mixed-meal diet and GAD65Ab was negative, thus he was diagnosed with ketosis-prone DM (KPDM). The increasing prevalence of obesity challenges the classic phenotype of patients with DM, with many patients presenting as an obese type T1D, and being diagnosed with T2D at a younger age. This complicates how to classify the patient’s diabetes, and the clinical profile is sometimes insufficient to make the proper diagnosis. In these cases, immunologic markers and assessment of β-cell function are important tools to differentiate between T1D and T2D, to direct management plans and to anticipate complications.
Diabetes Mellitus, Type 1 ; C-Peptide