PURPOSE: The RIFLE criteria (acronym indicating Risk of renal dysfunction; Injury to the kidney; Failure of kidney function, Loss of kidney function and End-stage kidney disease) was designed to provide a standardized method of classifying and reporting acute renal failure in the intensive care unit (ICU). No study in critically ill patients has reported the incidence of Loss of kidney function (“L”) and End-stage kidney disease (“E”) with the RIFLE classification. The aim of this study was to characterize acute kidney injury defined by the maximum RIFLE classification, including patients that meet criteria for “Loss” and “End-stage”.
METHODS: Retrospective cohort study, data including age, gender, race, urine output, baseline and worst creatinine levels; and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were collected from the institutional APACHE III database.Consecutive critically ill patients >18 years of age admitted to three ICUs of two tertiary care hospitals from January 2003 to December 2006, excluding those who denied research authorization, had a history of chronic renal replacement,or were admitted for low risk monitoring only.
RESULTS: Of 11291 patients who met the inclusion criteria, 1218 (10%) patients died in the hospital. There were 54% male patients, 90% were Caucasian, mean age (±SD) was 63± 17; median APACHE III score was 53 (IQR 38–69), and median baseline serum creatinine was 1.1 (IQR 0.9–1.4). Baseline creatinine levels were available for 11316 patients. No acute kidney injury was found in 5872 patients (50%), 3381 patients (29%) were classified as Risk, 1326 (12%) as Injury, and 715 (6%) as Failure. Follow up after ICU admission showed that 102 patients (1%) met criteria for Loss, and 248 (2%) for End-stage renal disease after development of acute kidney injury in the ICU.
CONCLUSION: A significant number of patients who developed acute kidney injury in the ICU, met criteria for “Loss” and “End-stage” according to the RIFLE classification.
CLINICAL IMPLICATIONS: Substantial number of critically survivors of acute kidney injury progress to loss and end-stage renal disease according to RIFLE criteria.
DISCLOSURE: Rodrigo Cartin-Ceba, No Financial Disclosure Information; No Product/Research Disclosure Information