Association of de novo dipstick albuminuria with severe acute kidney injury in critically ill septic patients

Background: Acute kidney injury (AKI) occurs frequently in septic patients. Albuminuria may play a role as an early marker of septic AKI. The potential association between de novo dipstick albuminuria (DA) and septic AKI has not been examined.

Methods: We conducted a single-center observational cohort study of 423 critically ill septic patients without chronic kidney disease (CKD) or prior positive DA within 3 months before admission. The association between de novo DA within the first 24 h of presentation and AKI at 72 h was examined.

Results: AKI was identified in 268/423 (63%) patients and 20/423 (4.7%) required dialysis. De novo DA was associated with AKI (univariate OR 1.91; 95% CI 1.27-2.86, p = 0.002). The association persisted in a multivariate logistic regression model adjusted for demographics, baseline kidney function, comorbidities, critical illness parameters, and exposure to nephrotoxins (adjusted OR 1.87; 95% CI 1.21-2.89, p = 0.005). The association between de novo DA and AKI was stronger for severe AKI, i.e. Acute Kidney Injury Network (AKIN) stage 3 (adjusted OR 2.99; 95% CI 1.52-5.85, p = 0.001) and AKIN stage 2 (adjusted OR 1.79; 95% CI 1.002-3.21, p = 0.049) but not AKIN stage 1 (adjusted OR 1.41; 95% CI 0.87-2.29, p = 0.16).

Conclusions: De novo DA within the first 24 h of admission was independently associated with severe AKI in critically ill septic patients. Future studies are required to fully elucidate the utility of DA testing in the early detection and stratification of AKI.