Acute Renal Failure After Cardiac Surgery: Evaluation of the RIFLE Classification

Kuitunen, Anne; Vento, Antti; Suojaranta-Ylinen, Raili; Pettilä, Ville

doi:10.1016/j.athoracsur.2005.07.047

Cited by 386 publications

(220 citation statements)

References 27 publications

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“…In a pediatric study, Perdensen et al (27) found a 11.5% incidence. Kuitunen et al (28) , evaluating adult patients, found a 19.3% rate, and these patients had less severe renal injury. This relevant difference may be explained by the fact of diagnosis of acute renal failure (ARF) in the pediatric study was made based on the urinary output (anuria or oliguria), hyperkalemia or volume excess, while in this study the pRIFLE criteria allowed earlier AKI diagnosis.…”

Section: Discussionmentioning

confidence: 96%

Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos

Freire¹,

Bresolin²,

Farah³

et al. 2010

Rev. bras. ter. intensiva

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Section: Discussionmentioning

confidence: 96%

Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos

Freire¹,

Bresolin²,

Farah³

et al. 2010

Rev. bras. ter. intensiva

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“…38 Based on an estimated 19% rate of postoperative acute kidney injury (RIFLE criteria) in the control arm, approximately 3,186 participants will be required to precisely measure a 20% relative risk reduction (alpha of 0.05, and power of 0.8). 39 Finally, randomization in the future study should be stratified by important determinants of acute kidney injury, such as preoperative renal function and surgical procedure. 23,40 Several design-related issues pertinent to this future trial remain unclear.…”

Section: Continuous Outcomes Difference || 95% CI Pmentioning

confidence: 99%

N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency

Wijeysundera

Beattie

Rao

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: N-acetylcysteine may prevent acute kidney injury after cardiac surgery. To determine if N-acetylcysteine warrants definitive evaluation in a large multicentre trial, we evaluated its effects on a surrogate outcome, estimated glomerular filtration rate (eGFR), in a randomized trial. Methods:One-hundred-seventy-seven cardiac surgery patients with moderate pre-existing renal insufficiency (eGFR ≤ 60 mL·min -1 ) were recruited in a blinded (patients, clinicians, datacollectors) placebo-controlled randomized trial. Eighty-nine were randomized to N-acetylcysteine (100 mg·kg -1 iv bolus, 20 mg·kg -1 ·hr -1 infusion until four hours after cardiopulmonary bypass), and 88 to placebo. The primary outcome was the percent change in eGFR during the first 72 postoperative hours. Secondary outcomes included renal replacement therapy, mortality, atrial fibrillation, vasoactive medications, and adverse effects. A future multicentre trial was deemed to be warranted if N-acetylcysteine was associated with a percent change in eGFR that was 3.8 better (small benefit), and with an upper 95% confidence interval including 9.5 (moderate benefit). Results: The median percent change in eGFR was 5.2% better (absolute difference) in the N-acetylcysteine arm (95% confidence interval 2.4% worse to 12.1% better; P = 0.22). With regard to secondary outcomes, all-cause mortality was lower in the N-acetylcysteine arm (0% vs 8%; P = 0.007). Conclusion:N-acetylcysteine did not cause a statistically significant improvement in postoperative eGFR in this singlecentre study. Nonetheless, its treatment effect was consistent with a plausible small-to-moderate benefit. Given this finding, N-acetylcysteine should be definitively evaluated in a large randomized trial.

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“…The RIFLE criteria have the advantage of providing diagnostic definitions for the stage at which kidney injury still can be prevented (risk stratum), the one when the kidney has already been damaged (injury), and the one when renal failure is established (failure). The RIFLE criteria have been tested in clinical practice and seem to be at least coherent with regard to outcome of the patient with AKI (11)(12)(13)(14)(15). Table 1 summarizes the five studies in which the RIFLE criteria have been evaluated in relation to patient outcome and need for RRT.…”

mentioning

confidence: 99%

Defining Acute Renal Failure

Biesen

Vanholder²,

Lameire³

2006

Clinical Journal of the American Society of Nephrology

156

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The introduction of the RIFLE classification has increased the conceptual understanding of the acute kidney injury (AKI) syndrome, and this classification has been successfully tested in a number of clinical studies. This review discusses the strengths and weaknesses of the RIFLE classification and suggests additional parameters to broaden future definitions of AKI. These definitions should not only focus on kidney function alone, but also include parameters describing the origin of the patient, the most important causal factors responsible for AKI and information on the pre-existing kidney function. This more complete definition should lead to a decrease in the variability of the results of epidemiological studies and of future clinical trials in AKI populations.

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Acute Renal Failure After Cardiac Surgery: Evaluation of the RIFLE Classification

Cited by 386 publications

References 27 publications

Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos

Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos

N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency

Defining Acute Renal Failure

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