• John W Pickering and Zoltán H Endre.
• Christchurch Kidney Research Group, Department of Medicine, University of Otago-Christchurch, PO Box 4345, Christchurch 8140, New Zealand. John.Pickering@otago.ac.nz
• Clin J Am Soc Nephrol. 2010 Jul 1; 5 (7): 1165-73.

Background And ObjectivesThe purpose of this study was to assess the viability of back-calculation with the Modification of Diet in Renal Disease (MDRD) formula to determine baseline creatinine on the basis of acute kidney injury (AKI) metrics, RIFLE criteria, and Acute Kidney Injury Network (AKIN) criteria for the purpose of clinical trial outcomes or epidemiology.Design, Setting, Participants, & MeasurementsThis study was a retrospective analysis of prospectively collected data from patients with measured baseline creatinines before entry to the intensive care unit (ICU). The AKI status was determined using five different baseline creatinines: the measured creatinine (the standard) and an estimated creatinine determined by back-calculation using MDRD assuming a GFR of 75 ml/min (epCr75), 100 ml/min (epCr100), randomly generating a value on a lognormal curve (epCrRnd), and choosing the lowest creatinine value within the first week in the ICU (epCrlow). A subgroup of patients without chronic kidney disease (CKD) was similarly analyzed.ResultsOf 224 patients, 70 (31%) had AKI according to RIFLE and 93 (42%) according to AKIN. The epCr75 and epCr100 distributions greatly overestimated the proportion with AKI. The epCrlow overestimated AKI according to AKIN but correctly estimated AKI according to RIFLE. The mean of 1000 epCrRnd distributions correctly estimated AKI according to RIFLE and AKIN. Each estimated distribution performed better in the non-CKD population with the exception of epCrRnd. However, only the epCrlow distribution accurately determined the proportion with AKI.ConclusionsA measured rather than estimated value should be used for baseline creatinine in trials or epidemiologic studies of AKI.

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