Continuous electronic monitoring of urine output identifies more AKI patients, and identifies them earlier, than serum creatinine alone

In a recently published paper describing a prospective study conducted in Israel, consecutive electronically monitored urine output (UO) identified significantly more cases of AKI according to the KDIGO criteria than serum creatinine (SCr) alone. Additionally, in patients that fulfilled AKI definitions using both the SCr and UO criteria, electronic UO measurements identified AKI significantly earlier than SCr.

The study

The aim of the study was to assess and compare the performance of the two KDIGO criteria (SCr and UO) for identification of AKI in the ICU by comparing the standard SCr criteria to real-time, consecutive electronic UO measurements with the Clarity RMS.

Hourly electronic UO measurements and twice-daily Serum Creatinine levels were recorded in 95 catheterized ICU patients for 24-48 hours and up to a week, respectively, after ICU admission.

The results

Real-time consecutive UO measurements identified significantly more AKI patients than SCr: 57.9% (N = 55) versus 26.4% (N = 25), respectively (P < 0.0001).

In 20 patients that had AKI according to both criteria, time to AKI identification was significantly shorter using electronic UO vs. SCr (P < 0.0001). Among this population, the median identification time of AKI with electronic UO was 12.75 hours from ICU admission vs. 39.06 hours for SCr.


The authors state that electronic UO monitoring provides a uniform and consistent definition for identifying AKI patients in the ICU according to the KDIGO criteria. They conclude that application of the KDIGO criteria for AKI using continuous monitoring of UO identifies more AKI patients, and identifies them earlier, than SCr alone.


Willner, D., Goldman, A., Azran, H. et al. Early identification of acute kidney injury in the ICU with real-time urine output monitoring: a clinical investigation. BMC Nephrol 22, 293 (2021).

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