A Retrospective Study of Acute Kidney Injury in Cats and Development of a Novel Clinical Scoring System for Predicting Outcome for Cats Managed by Hemodialysis

G. Segev, R. Nivy, Philip H Kass, Larry D Cowgill

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Information regarding acute kidney injury (AKI) in cats is limited, and there are no reliable tools to objectively assess disease severity and predict outcome. Objectives: To assess clinical signs, clinicopathologic abnormalities, etiology, and outcome of cats with AKI, and to develop models using clinical metrics and empirically derived scores to predict outcome. Animals: One hundred and thirty-two client-owned cats. Methods: Retrospective study. Bivariate logistic regression analyses were performed to identify variables predictive of 30-day survival. Continuous variables outside the reference range were divided into quartiles to yield quartile-specific odds ratios (OR) for survival. Models were developed incorporating weighting factors assigned to each quartile based on the OR. A predictive score for each model was calculated for each cat by summing all weighting factors. A second, multivariable logistic regression model was created from actual values of the same variables. Receiver operating characteristic curve analyses were performed to determine the models' performance. Models were further tested using a subset of cases not used in initial assessment. Results: Fifty five of 132 cats (42%) remained dialysis-independent for at least 30 days after discharge, and the remaining 77 cats either died (n = 37, 28%) or were euthanized (n = 40, 30%). The most common etiology was ureteral obstruction (n = 46, 35%). Higher scores were associated with decreased probability of survival (P < .001). Models correctly classified outcomes in 75-77% of the cases and 84-89% of the cases in the subsequent evaluation. Conclusions and Clinical Importance: Models can provide objective guidance in assessing AKI prognosis and severity, but should be validated in other cohorts of cats.

Original languageEnglish (US)
Pages (from-to)830-839
Number of pages10
JournalJournal of Veterinary Internal Medicine
Volume27
Issue number4
DOIs
StatePublished - Jul 2013

Fingerprint

hemodialysis
Acute Kidney Injury
retrospective studies
Renal Dialysis
Cats
Retrospective Studies
kidneys
cats
Logistic Models
odds ratio
etiology
Odds Ratio
Ureteral Obstruction
ROC Curve
dialysis
Dialysis
Reference Values
disease severity
prognosis
Regression Analysis

Keywords

  • Acute renal failure
  • Model
  • Risk factor
  • Score
  • Survival

ASJC Scopus subject areas

  • veterinary(all)

Cite this

@article{2d7bb59c3b0b4046b3ad7257608d52f9,
title = "A Retrospective Study of Acute Kidney Injury in Cats and Development of a Novel Clinical Scoring System for Predicting Outcome for Cats Managed by Hemodialysis",
abstract = "Background: Information regarding acute kidney injury (AKI) in cats is limited, and there are no reliable tools to objectively assess disease severity and predict outcome. Objectives: To assess clinical signs, clinicopathologic abnormalities, etiology, and outcome of cats with AKI, and to develop models using clinical metrics and empirically derived scores to predict outcome. Animals: One hundred and thirty-two client-owned cats. Methods: Retrospective study. Bivariate logistic regression analyses were performed to identify variables predictive of 30-day survival. Continuous variables outside the reference range were divided into quartiles to yield quartile-specific odds ratios (OR) for survival. Models were developed incorporating weighting factors assigned to each quartile based on the OR. A predictive score for each model was calculated for each cat by summing all weighting factors. A second, multivariable logistic regression model was created from actual values of the same variables. Receiver operating characteristic curve analyses were performed to determine the models' performance. Models were further tested using a subset of cases not used in initial assessment. Results: Fifty five of 132 cats (42{\%}) remained dialysis-independent for at least 30 days after discharge, and the remaining 77 cats either died (n = 37, 28{\%}) or were euthanized (n = 40, 30{\%}). The most common etiology was ureteral obstruction (n = 46, 35{\%}). Higher scores were associated with decreased probability of survival (P < .001). Models correctly classified outcomes in 75-77{\%} of the cases and 84-89{\%} of the cases in the subsequent evaluation. Conclusions and Clinical Importance: Models can provide objective guidance in assessing AKI prognosis and severity, but should be validated in other cohorts of cats.",
keywords = "Acute renal failure, Model, Risk factor, Score, Survival",
author = "G. Segev and R. Nivy and Kass, {Philip H} and Cowgill, {Larry D}",
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T1 - A Retrospective Study of Acute Kidney Injury in Cats and Development of a Novel Clinical Scoring System for Predicting Outcome for Cats Managed by Hemodialysis

AU - Segev, G.

AU - Nivy, R.

AU - Kass, Philip H

AU - Cowgill, Larry D

PY - 2013/7

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N2 - Background: Information regarding acute kidney injury (AKI) in cats is limited, and there are no reliable tools to objectively assess disease severity and predict outcome. Objectives: To assess clinical signs, clinicopathologic abnormalities, etiology, and outcome of cats with AKI, and to develop models using clinical metrics and empirically derived scores to predict outcome. Animals: One hundred and thirty-two client-owned cats. Methods: Retrospective study. Bivariate logistic regression analyses were performed to identify variables predictive of 30-day survival. Continuous variables outside the reference range were divided into quartiles to yield quartile-specific odds ratios (OR) for survival. Models were developed incorporating weighting factors assigned to each quartile based on the OR. A predictive score for each model was calculated for each cat by summing all weighting factors. A second, multivariable logistic regression model was created from actual values of the same variables. Receiver operating characteristic curve analyses were performed to determine the models' performance. Models were further tested using a subset of cases not used in initial assessment. Results: Fifty five of 132 cats (42%) remained dialysis-independent for at least 30 days after discharge, and the remaining 77 cats either died (n = 37, 28%) or were euthanized (n = 40, 30%). The most common etiology was ureteral obstruction (n = 46, 35%). Higher scores were associated with decreased probability of survival (P < .001). Models correctly classified outcomes in 75-77% of the cases and 84-89% of the cases in the subsequent evaluation. Conclusions and Clinical Importance: Models can provide objective guidance in assessing AKI prognosis and severity, but should be validated in other cohorts of cats.

AB - Background: Information regarding acute kidney injury (AKI) in cats is limited, and there are no reliable tools to objectively assess disease severity and predict outcome. Objectives: To assess clinical signs, clinicopathologic abnormalities, etiology, and outcome of cats with AKI, and to develop models using clinical metrics and empirically derived scores to predict outcome. Animals: One hundred and thirty-two client-owned cats. Methods: Retrospective study. Bivariate logistic regression analyses were performed to identify variables predictive of 30-day survival. Continuous variables outside the reference range were divided into quartiles to yield quartile-specific odds ratios (OR) for survival. Models were developed incorporating weighting factors assigned to each quartile based on the OR. A predictive score for each model was calculated for each cat by summing all weighting factors. A second, multivariable logistic regression model was created from actual values of the same variables. Receiver operating characteristic curve analyses were performed to determine the models' performance. Models were further tested using a subset of cases not used in initial assessment. Results: Fifty five of 132 cats (42%) remained dialysis-independent for at least 30 days after discharge, and the remaining 77 cats either died (n = 37, 28%) or were euthanized (n = 40, 30%). The most common etiology was ureteral obstruction (n = 46, 35%). Higher scores were associated with decreased probability of survival (P < .001). Models correctly classified outcomes in 75-77% of the cases and 84-89% of the cases in the subsequent evaluation. Conclusions and Clinical Importance: Models can provide objective guidance in assessing AKI prognosis and severity, but should be validated in other cohorts of cats.

KW - Acute renal failure

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