Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications

Lopes, José António; Fernandes, Paulo Irineu Barreto; Jorge, Sofía; Gonçalves, Sara; Álvarez, Antonio; Silva, Zélia Costa e; Franca, Carlos Antônio da Silva; Prata, Mateus Martins

doi:10.1186/cc6997

Cited by 238 publications

(191 citation statements)

References 26 publications

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“…The conclusion revealed that some participants with AKI were undiagnosed and no proportional increase between mortality rate and AKI stages. 19,20 Following the insufficiency of serum creatinine responsible for AKI, the next major quantum of deficiency in the field arose from the understanding that the limitations of the urine output criteria and inappropriately identifying prognostic factors of mortality in patients with AKI. 21,22 Because the factors including volume status and nutrition status that affect creatinine, serum creatinine was found to be subnormal standard biomarker for AKI.…”

Section: Discussionmentioning

confidence: 99%

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Wang

Chen

et al. 2015

Renal Failure

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(2015) The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study, Renal Failure, 37:6,[985][986][987][988][989][990][991][992][993] CLINICAL STUDYThe association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study Objectives: The severity of acute kidney injury (AKI) has been a well-known predictor for inhospital mortality. Whether AKI duration could predict in-hospital mortality is not clear. This study determines the association between the in-hospital mortality and AKI duration in patients after non-cardiac surgery. Materials and methods: Surgical patients who were admitted to the ICU were enrolled. AKI cases were defined using KDIGO guidelines and categorized according to the tertiles of AKI duration (1st tertile: 2 days, 2nd tertile: 3-6 days and 3rd tertile: 7 days). The adjusted hazard ratios (HRs) for in-hospital mortality are compared to those without AKI. The predictability of mortality is accessed by calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve. Results: From a total of 318 postoperative patients, 98 developed AKI (1st tertile: 34 cases, 2nd tertile: 30 cases and 3rd tertile: 34 cases) and 220 had no AKI. The in-hospital mortality rates are 6.8% (non-AKI), 50% (1st tertile), 46.7% (2nd tertile) and 47% (3rd tertile). The HR's for in-hospital mortality are 7.92, 6.68 and 1.68, compared to the non-AKI group (p ¼ 0.006, 0.021 and 0.476). Cumulative in-hospital survival rates are significantly different for the non-AKI group and the AKI groups (p50.001). The AUC for AKI duration and stage together (0.804) is higher than that for AKI stage and AKI duration alone (0.803 and 0.777) (both ps50.001). Conclusion: In addition to severity, the duration of AKI may be a predictor of in-hospital mortality in patients, after non-cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Wang

Chen

et al. 2015

Renal Failure

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“…The few studies [47,48] that have compared the AKIN and RIFLE criteria have revealed no substantial differences. Chang et al [49] retrospectively investigated 291 critically ill patients and compared performance of the RIFLE and AKIN criteria for diagnosing and classifying AKI and for predicting hospital mortality.…”

Section: Criteria In General Icumentioning

confidence: 99%

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Lin

Chen

2012

WJCCM

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Acute kidney injury (AKI) is a common and serious complication in critically ill patients. The mortality rate remains high despite improved renal replacement techniques. A possible cause of the high mortality rate is that intensive care unit patients tend to be older and more debilitated than before. Pathophysiological factors associated with AKI are also implicated in the failure of other organs, indicating that AKI is often part of a multiple organ failure syndrome. Until recently, there was a lack of consensus as to the best definition, characterization, and evaluation of acute renal failure. This lack of a standard definition has been a major impediment to progress in clinical and basic research. The introduction of the risk, injury, failure, loss, and end-stage kidney disease criteria and the modified version proposed by the Acute Kidney Injury Network have increased the conceptual understanding of AKI syndrome, and these criteria have been successfully tested in clinical studies. This article reviews current findings concerning the application of these criteria for assessing epidemiology and predicting outcome in specific homogeneous critically ill patient groups.

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“…Nevertheless, even after ageadjustment of the back-estimation formulae, the results did not improve. Unfortunately, many investigations have used an estimation of bSCr in up to 50% of their patients (11)(12)(13)(14)(15)29,30). As we and others have found (6,11,24), the estimated bSCr is inadequate when precise case adjudication is required, for example, in defining mild AKI stages (25).…”

Section: Discussionmentioning

confidence: 98%

“…Because the current models used to estimate bSCr values explain only a very limited amount of variation for any given age group, they have little validity for estimating bSCr as a replacement for the measured values. Therefore, the use of these formulae to classify a state of disease in clinical investigations (11)(12)(13)(14)(15)29,30) induces an important bias, and results should be interpreted very carefully.…”

Section: Discussionmentioning

confidence: 99%

Serum Creatinine Back-Estimation in Cardiac Surgery Patients

Bernardi¹,

Schmidlin

Ristl

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives A knowledge of baseline serum creatinine (bSCr) is mandatory for diagnosing and staging AKI. With often missing values, bSCr is estimated by back-calculation using several equations designed for the estimation of GFR, assuming a "true" GFR of 75 ml/min per 1.73 m 2 . Using a data set from a large cardiac surgery cohort, we tested the appropriateness of such an approach and compared estimated and measured bSCr. Moreover, we designed a novel data-driven model (estimated serum creatinine [eSCr]) for estimating bSCr. Finally, we analyzed the extent of AKI and mortality rate misclassifications.Design, setting, participants, & measurements Data for 8024 patients (2833 women) in our cardiac surgery center were included from 1997 to 2008. Measured and estimated bSCr were plotted against age for men and women. Patients were classified to AKI stages defined by the Kidney Disease Improving Global Outcomes (KDIGO) group. Results were compared with data from another cardiac surgery center in Zurich, Switzerland.Results The Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration formulae describe higher estimated bSCr values in younger patients, but lower values in older patients compared with the measured bSCr values in both centers. The Pittsburgh Linear Three Variables formula correctly describes the increasing bSCr with age, however, it underestimates the overall bSCr level, being in the range of the 25% quantile of the measured values. Our eSCr model estimated measured bSCr best. AKI stage 1 classification using all formulae, including our eSCr model, was incorrect in 53%-80% of patients in Vienna and in 74%-91% in Zurich; AKI severity (according to KDIGO stages) and also mortality were overestimated. Mortality rate was higher among patients falsely classified into higher KDIGO stages by estimated bSCr.Conclusions bSCr values back-estimated using currently available eGFR formulae are inaccurate and cannot correctly classify AKI stages. Our model eSCr improves the prediction of AKI but to a still inadequate extent.

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Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications

Cited by 238 publications

References 26 publications

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Serum Creatinine Back-Estimation in Cardiac Surgery Patients

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