KDIGO acute kidney injury staging

What goes into the KDIGO AKI stage

• Baseline creatinine (mg/dL)
• Current creatinine (mg/dL)
• Urine output: Normal or not measured; < 0.5 mL/kg/h for 6–12 h; < 0.5 mL/kg/h for ≥ 12 h; < 0.3 mL/kg/h for ≥ 24 h, or anuria ≥ 12 h
• Dialysis started

How to interpret the result

• Stage 1: creatinine 1.5–1.9× baseline or rise ≥ 0.3 mg/dL; or urine < 0.5 mL/kg/h for 6–12 h
• Stage 2: 2.0–2.9× baseline; or urine < 0.5 mL/kg/h for ≥ 12 h
• Stage 3: ≥ 3× baseline, creatinine ≥ 4.0 mg/dL, or dialysis; or urine < 0.3 mL/kg/h for ≥ 24 h or anuria ≥ 12 h

Clinical pearls

• Use the lowest creatinine in the past 3 months as the baseline if no recent value exists.
• Stage by whichever criterion (creatinine or urine output) gives the higher stage.
• Creatinine lags behind injury; urine output falls earlier.

Evidence

1. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2:1-138.

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