{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:45:10Z","timestamp":1791884710957,"version":"4.3.4"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007605","name":"Aarhus University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007605","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005747","name":"A.P. M\u00f8ller Foundation","doi-asserted-by":"publisher","award":["L-2021-00257"],"award-info":[{"award-number":["L-2021-00257"]}],"id":[{"id":"10.13039\/501100005747","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Canadian Institutes for Health Research Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Within the current criteria for acute kidney injury (AKI), it remains debated whether small absolute creatinine increases are associated with higher mortality in patients with low baseline estimated glomerular filtration rates (eGFRs), and whether these changes carry prognostic value comparable to relative increases. We therefore examined the prognostic impact of rapid creatinine increases across baseline eGFRs in patients undergoing major elective surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We pooled data on patients undergoing major elective surgery from Canada, Denmark, Scotland, and Wales. This clinical setting was chosen because creatinine levels in this group are routinely monitored both before and after an acute stress event, regardless of clinical status. We ascertained the highest relative creatinine increase within 7 days and the highest absolute creatinine increase within 2 days during the first 7 days after surgery. We used logistic regressions with splines and interaction terms to construct heatmaps depicting age-, sex-, year-, and surgery type-standardized 90-day mortality according to creatinine increases across baseline eGFRs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 311\u2009975 surgical procedures performed in 279\u2009554 patients, with 11\u2009568 deaths. Compared to no change in creatinine, a 0.3 mg\/dl (26.5 \u00b5mol\/l) absolute increase was associated with a consistent 2.2\u20133.3 percentage point increase in mortality for eGFR between 15 and 90 ml\/min\/1.73 m2. However, while the excess mortality associated with a 0.3 mg\/dl and a 50% creatinine increase was similar at baseline eGFR of 90 ml\/min\/1.73 m2, the excess mortality of a 50% creatinine increase was substantially greater among those with baseline eGFRs\u00a0&amp;lt;30 ml\/min\/1.73 m2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A small absolute creatinine increase of 0.3 mg\/dl is associated with a consistent increase in mortality across baseline eGFRs, indicating its relevance as a component of the AKI criteria. However, the higher excess mortality associated with a 50% increase at low eGFRs should be emphasized in future guidelines to improve clinical discussions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag319","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:52:54Z","timestamp":1791373974000},"source":"Crossref","is-referenced-by-count":0,"title":["Creatinine increases have consistent and differential prognostic impact across kidney function"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8239-2970","authenticated-orcid":false,"given":"Philip Vestergaard","family":"Munch","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Sawhney","sequence":"additional","affiliation":[{"name":"Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen , Aberdeen ,","place":["UK"]},{"name":"NHS Grampian , Aberdeen ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uffe","family":"Heide-J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0032-131X","authenticated-orcid":false,"given":"Simon Kok","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9100-1575","authenticated-orcid":false,"given":"Samira","family":"Bell","sequence":"additional","affiliation":[{"name":"Division of Population Health and Genomics, University of Dundee , Dundee ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Yeung","sequence":"additional","affiliation":[{"name":"BHF\/University Centre for Cardiovascular Science, Little France Crescent, University of Edinburgh , Edinburgh, EH16 4SA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, O\u2019Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary, Alberta ,","place":["Canada"]},{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary , Calgary, Alberta ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Scale","sequence":"additional","affiliation":[{"name":"University of Swansea , Swansea ,","place":["UK"]},{"name":"NHS Wales , Swansea ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1876-3917","authenticated-orcid":false,"given":"Matthew Thomas","family":"James","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, O\u2019Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary, Alberta ,","place":["Canada"]},{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary , Calgary, Alberta ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-953X","authenticated-orcid":false,"given":"Christian Fynbo","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology, Aarhus University Hospital , Aarhus ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"2026101304514190800_bib1","first-page":"1","article-title":"Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. 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