The kinetic estimated glomerular filtration rate ratio predicts acute kidney injury

Nephrology (Carlton). 2021 Oct;26(10):782-789. doi: 10.1111/nep.13918. Epub 2021 Jul 20.


Aim: Kinetic estimated Glomerular Filtration Rate (KeGFR) approximates GFR under non-steady-state conditions. We investigated whether the ratio of KeGFR difference to baseline eGFR could predict acute kidney injury (AKI) earlier than a creatinine-based algorithm that triggered an AKI electronic Alert (eAlert).

Methods: This retrospective, single-centre, proof-of-concept cohort study assessed all patients diagnosed with AKI by an automated serum creatinine-based eAlert. The kinetic eGFR, the kinetic eGFR difference from baseline and the ratio of difference to baseline was calculated in subjects with at least two serum creatinine (sCr) measurements within 72 h of AKI.

Results: Patients in the AKI cohort (n = 140) had a significant decline in KeGFR ratio (AKI: 17% IQR 7% to 29%, Non-AKI: 0 IQR -12% to 9%; P-value <.0001). A decrease of the ratio greater than 10% predicted AKI with a sensitivity of 66%, a specificity of 77%, a positive predictive value of 63%, and negative predictive value of 80%. The median lead time between KeGFR ratio decrease and AKI was 24 h (IQR: 19-27 h).

Conclusions: KeGFR ratio is a cheap, simple method that predicted AKI 24 h before laboratory detection. KeGFR may facilitate triaging patients to increased monitoring or intervention.

Keywords: acute kidney injury; eAlert; early detection; glomerular filtration rate; kinetic eGFR.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / physiopathology
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Creatinine / blood*
  • Early Diagnosis
  • Female
  • Glomerular Filtration Rate*
  • Hospitalization
  • Humans
  • Kidney / physiopathology*
  • Kinetics
  • Male
  • Middle Aged
  • New South Wales
  • Predictive Value of Tests
  • Proof of Concept Study
  • Retrospective Studies


  • Biomarkers
  • Creatinine