{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:01:48Z","timestamp":1787907708340,"version":"build-2784847793"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T00:00:00Z","timestamp":1664150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Creatinine is widely used to estimate renal function, but this is not practical in critical illness. Low creatinine has been associated with mortality in many clinical settings. However, the associations between predialysis creatinine level, Sepsis-related Organ Failure Assessment (SOFA) score, fluid overload, and mortality in acute kidney injury patients receiving dialysis therapy (AKI-D) has not been fully addressed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We extracted data for AKI-D patients in the eICU and MIMIC databases. We conducted a retrospective observational cohort study using the eICU dataset. The study cohort was divided into the high-creatine group and the low-creatinine group by the median value (4 mg\/dL). The baseline patient information included demographic data, laboratory tests, medications, and comorbid conditions. The independent association of creatinine level with 30-day mortality was examined using multivariate logistic regression analysis. In sensitivity analyses, the associations between creatinine, SOFA score, and mortality were analyzed in patients with or without fluid overload. We also carried out an external validity using the MIMIC dataset.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In all 1,600 eICU participants, the <jats:italic>30<\/jats:italic>-day mortality rate was 34.2%. The crude overall mortality rate in the low-creatinine group (44.9%) was significantly higher than that in the high-creatinine group (21.9%; <jats:italic>P<\/jats:italic> &lt; 0.001). In the fully adjusted models, the low-creatinine group was associated with a higher risk of 30-day mortality (odds ratio, 1.77; 95% confidence interval, 1.29\u20132.42; <jats:italic>P<\/jats:italic> &lt; 0.001) compared with the high-creatinine group. The low-creatinine group had higher SOFA and nonrenal SOFA scores. In sensitivity analyses, the low-creatinine group had a higher 30-day mortality rate with regard to the BMI or albumin level. Fluid overloaded patients were associated with a significantly worse survival in the low-creatinine group. The results were consistent when assessing the external validity using the MIMIC dataset.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In patients with AKI-D, lower predialysis creatinine was associated with increased mortality risk. Moreover, the mortality rate was substantially higher in patients with lower predialysis creatinine with concomitant elevation of fluid overload status.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0274883","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T17:40:55Z","timestamp":1664214055000},"page":"e0274883","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Association between predialysis creatinine and mortality in acute kidney injury patients requiring dialysis"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3180-5154","authenticated-orcid":true,"given":"Hsin-Hsiung","family":"Chang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Lin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Chieh","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Fang","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,26]]},"reference":[{"issue":"8","key":"pone.0274883.ref001","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s00134-015-3934-7","article-title":"Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study","volume":"41","author":"EA 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Kashani","year":"2020","journal-title":"European journal of internal medicine"},{"issue":"1","key":"pone.0274883.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-019-55362-w","article-title":"The association of low admission serum creatinine with the risk of respiratory failure requiring mechanical ventilation: a retrospective cohort study","volume":"9","author":"C Thongprayoon","year":"2019","journal-title":"Scientific reports"},{"issue":"1","key":"pone.0274883.ref012","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/CCM.0000000000001348","article-title":"The association between low admission peak plasma creatinine concentration and in-hospital mortality in patients admitted to intensive care in Australia and New Zealand","volume":"44","author":"AA Udy","year":"2016","journal-title":"Critical Care 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A prospective cohort study","volume":"16","author":"A Stein","year":"2012","journal-title":"Critical Care"},{"issue":"6","key":"pone.0274883.ref017","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1038\/sj.ki.5001579","article-title":"Mortality after acute renal failure: models for prognostic stratification and risk adjustment","volume":"70","author":"G Chertow","year":"2006","journal-title":"Kidney international"},{"issue":"1","key":"pone.0274883.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/sdata.2016.35","article-title":"MIMIC-III, a freely accessible critical care database","volume":"3","author":"AE Johnson","year":"2016","journal-title":"Scientific data"},{"key":"pone.0274883.ref019","doi-asserted-by":"crossref","first-page":"180178","DOI":"10.1038\/sdata.2018.178","article-title":"The eICU Collaborative Research Database, a freely available multi-center database for critical care research","volume":"5","author":"TJ Pollard","year":"2018","journal-title":"Scientific data"},{"issue":"1","key":"pone.0274883.ref020","first-page":"1","article-title":"Work Group. KDIGO clinical practice guideline for acute kidney injury","volume":"2","author":"A. 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