The Patient with Acute Kidney Injury

Clinical Kidney Journal, 2013

In May 2004, a new classification, the RIFLE (Risk, Injury, Failure, Loss of kidney function, and Endstage kidney disease) classification, was proposed in order to define and stratify the severity of acute kidney injury (AKI). This system relies on changes in the serum creatinine (SCr) or glomerular filtration rates and/or urine output, and it has been largely demonstrated that the RIFLE criteria allows the identification of a significant proportion of AKI patients hospitalized in numerous settings, enables monitoring of AKI severity, and is a good predictor of patient outcome. Three years later (March 2007), the Acute Kidney Injury Network (AKIN) classification, a modified version of the RIFLE, was released in order to increase the sensitivity and specificity of AKI diagnosis. Until now, the benefit of these modifications for clinical practice has not been clearly demonstrated. Here we provide a critical and comprehensive discussion of the two classifications for AKI, focusing on the main differences, advantages and limitations.

Nephrology, 2008

Aim: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor.Methods: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed.Results: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality.Conclusion: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system.

Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2013

Acute kidney injury (AKI) is commonly occurred in intensive care unit (ICU) patients. The aim of the study was a comparison of RIFLE (Risk of renal injury/Injury to the kidney/Failure of kidney function/Loss of kidney function/End stage disease) classification with other scoring systems in the evaluation of AKI in ICUs. We performed a retrospective study on 409 ICU patients who were admitted during the 5 years period. At the 1(st) day of admission and time of discharge, the total and non-renal Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores were compared to max RIFLE criteria. In this assessment, there was concordance among the results (P < 0.05). The RIFLE classification can be used for detection of AKI in ICU patients.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2012

Acute kidney injury (AKI) is common in the intensive care unit (ICU) and is associated with significant morbidity and mortality. This requires clinicians to be familiar with recent advances in definitions, diagnosis, prevention, and management of AKI in the ICU. The Acute Dialysis Quality Initiative (ADQI) represents the efforts of a workgroup seeking to develop consensus and evidence-based statements in the field of AKI. The ADQI group proposed a consensus graded definition, called the RIFLE criteria (Risk, Injury, Failure, Loss, and End stage). Objective: To estimate the prevalence of AKI in ICU and assess the ability of the RIFLE criteria to predict the outcome of AKI in ICU. Methods: We performed a retrospective cohort study in the internal medicine ICU, Zagazig University Hospital, in the period from January 2010 to December 2010. We excluded patients younger than 15 years, patients receiving chronic hemodialysis admitted to ICU, kidney transplant patients, length of hospital stays were <24 hours, or readmitted to the ICU during the study period. RIFLE criteria classified AKI patients into three stages of increasing severity Risk(R), Injury (I), and Failure (F). The outcomes of AKI patients in ICU were recovery, kidney loss, end stage renal disease (ESRD) or death. Results: The total number of ICU admissions during the study period was 8304 patients. After application of exclusion criteria, the number of the study became 5440 patients. According to RIFLE criteria 1885 (34.65%) had AKI. RIFLE criteria classified them into Risk 13.32%, Injury 11.91% and Failure 9.41%. The crude outcome of AKI patients as follow 77.24% recovered, 9% lost kidney functions and required renal replacement therapy (RRT), and 2.28% reached ESRD. The crude mortality of AKI patients was 20.47% versus 7.76% mortality in patients without AKI. The hospital recovery stratified by RIFLE criteria decreased with worsening RIFLE classes (R, I, F) 84.27%, 79.62% and 64.25% respectively. Patients' lost kidney functions and required RRT stratified by RIFLE criteria increased with worsening RIFLE classes 5.79%, 7.4% and15.62% respectively. Patients reached ESRD stratified by RIFLE criteria increased with worsening RIFLE classes 1.2%, 2% and 4.1% respectively. The hospital mortality AKI patients stratified by RIFLE criteria increased with worsening RIFLE classes 14.48%, 18.36% and 31.64% respectively. The urinary output (UOP) criteria associated with lower mortality and higher recovery rate than creatinine criteria. Conclusion: The prevalence of AKI in the internal medicine ICU, Zagazig University Hospital according to RIFLE criteria is 34.65%. RIFLE criteria are useful in predicting the outcome of AKI patients. [Mohamed Fouad and Mabrouk I. Ismail.Prevalence and Outcome of Acute Kidney Injury in the intensive care unit according to RIFLE criteria: A single-center study. Journal of American Science 2011; 7(6):1005-1012].(ISSN: 1545-1003). http://www.americanscience.org.

Critical care (London, England), 2006

The lack of a standard definition for acute kidney injury has resulted in a large variation in the reported incidence and associated mortality. RIFLE, a newly developed international consensus classification for acute kidney injury, defines three grades of severity--risk (class R), injury (class I) and failure (class F)--but has not yet been evaluated in a clinical series. We performed a retrospective cohort study, in seven intensive care units in a single tertiary care academic center, on 5,383 patients admitted during a one year period (1 July 2000-30 June 2001). Acute kidney injury occurred in 67% of intensive care unit admissions, with maximum RIFLE class R, class I and class F in 12%, 27% and 28%, respectively. Of the 1,510 patients (28%) that reached a level of risk, 840 (56%) progressed. Patients with maximum RIFLE class R, class I and class F had hospital mortality rates of 8.8%, 11.4% and 26.3%, respectively, compared with 5.5% for patients without acute kidney injury. Addi...

Nephron Clinical Practice, 2011

PLOS Medicine, 2016

• Acute Kidney Injury (AKI) is defined using widely accepted international criteria that are based on changes in serum creatinine concentration and degree of oliguria. • AKI, when defined in this way, has a strong association with poor patient outcomes, including high mortality rates and longer hospital admissions with increased resource utilisation and subsequent chronic kidney disease. • The detection of AKI using current criteria can assist with AKI diagnosis and stratification of individual patient risk. • The diagnosis of AKI requires clinical judgement to integrate the definition of AKI with the clinical situation, to determine underlying cause of AKI, and to take account of factors that may affect performance of current definitions.

Critical Care, 2008

Introduction Whether discernible advantages in terms of sensitivity and specificity exist with Acute Kidney Injury Network (AKIN) criteria versus Risk, Injury, Failure, Loss of Kidney Function, End-stage Kidney Disease (RIFLE) criteria is currently unknown. We evaluated the incidence of acute kidney injury and compared the ability of the maximum RIFLE and of the maximum AKIN within intensive care unit hospitalization in predicting inhospital mortality of critically ill patients.

Kidney international, 2015

Acute kidney injury (AKI) is a common syndrome that is independently associated with increased mortality. A standardized definition is important to facilitate clinical care and research. The definition of AKI has evolved rapidly since 2004, with the introduction of the Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) classifications. RIFLE was modified for pediatric use (pRIFLE). They were developed using both evidence and consensus. Small rises in serum creatinine are independently associated with increased mortality, and hence are incorporated into the current definition of AKI. The recent definition from the international KDIGO guideline merged RIFLE and AKIN. Systematic review has found that these definitions do not differ significantly in their performance. Health-care staff caring for children or adults should use standard criteria for AKI, such as the pRIFLE or KDIGO definitions, respect...