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Fractional excretion of electrolytes in volume‐responsive and intrinsic acute kidney injury in dogs: Diagnostic and prognostic implications

Troìa, Roberta, Gruarin, Marta, Grisetti, Chiara, Serafini, Federica, Magna, Luca, Monari, Erika, Giunti, Massimo, Dondi, Francesco
Journal of veterinary internal medicine 2018 v.32 no.4 pp. 1372-1382
death, dogs, electrolytes, excretion, guidelines, kidneys, mortality, prospective studies, regression analysis, risk factors, sodium
BACKGROUND: The value of fractional excretion (FE) of electrolytes to characterize and prognosticate acute kidney injury (AKI) is poorly documented in dogs. OBJECTIVES: To evaluate the diagnostic and prognostic roles of FE of electrolytes in dogs with AKI. ANIMALS: Dogs (n = 135) with AKI treated with standard care (February 2014‐December 2016). METHODS: Prospective study. Clinical and laboratory variables including FE of electrolytes, were measured upon admission. Dogs were graded according to the AKI‐IRIS guidelines and grouped according to AKI features (volume‐responsive, VR‐AKI; intrinsic, I‐AKI) and outcome (survivors/non‐survivors). Group comparison and regression analyses with hazard ratios (HR) evaluation for I‐AKI and mortality were performed. P < .05 was considered significant. RESULTS: Fifty‐two of 135 (39%) dogs had VR‐AKI, 69/135 (51%) I‐AKI and 14/135 (10%) were unclassified. I‐AKI dogs had significantly higher FE of electrolytes, for example, FE of sodium (FENa, %) 2.39 (range 0.04‐75.81) than VR‐AKI ones 0.24 (range 0.01‐2.21; P < .001). Overall, case fatality was 41% (55/135). Increased FE of electrolytes were detected in nonsurvivors, for example, FENa 1.60 (range 0.03‐75.81) compared with survivors 0.60 (range 0.01‐50.45; P = .004). Several risk factors for death were identified, including AKI‐IRIS grade (HR = 1.39, P = .002), FE of electrolytes, for example, FENa (HR = 1.03, P < .001), and urinary output (HR = 5.06, P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Fractional excretion of electrolytes performed well in the early differentiation between VR‐AKI and I‐AKI, were related to outcome, and could be useful tools to manage AKI dogs in clinical practice.