Discrepancies in the RIFLE classification are due to the method used to assess the level of derangement of kidney function

Herrera-Gutiérrez, M.E.; Seller-Pérez, G.; Banderas-Bravo, Esther; Aragón-González, César; Olalla-Sánchez, Rebeca; Lozano-Saéz, R.

doi:10.1016/j.jcrc.2011.02.006

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…This inevitable time window will condition a delay in the detection of AKI. Yet another problem with RIFLE arises from the possibility to choose indistinctly between CrCl or Crs, even when these values are not linearly related and do not change simultaneously in time [46]. Another relevant aspect and one that questions the consistency of these systems is the finding of similar outcomes for patients in the AKIN 1 and 2 levels with a significant increment for level 3 and with a similar behavior for RIFLE [47] that could be suggesting the convenience for a reappraisal of the ranges of Crs considered in each level.…”

Section: Stratification Of Akimentioning

confidence: 99%

Estimating Kidney Function in the Critically Ill Patients

Seller-Pérez

Herrera-Gutiérrez

Maynar-Moliner

et al. 2013

Critical Care Research and Practice

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Glomerular filtration rate (GFR) is an accepted measure for assessment of kidney function. For the critically ill patient, creatinine clearance is the method of reference for the estimation of the GFR, although this is often not measured but estimated by equations (i.e., Cockroft-Gault or MDRD) not well suited for the critically ill patient. Functional evaluation of the kidney rests in serum creatinine (Crs) that is subjected to multiple external factors, especially relevant overhydration and loss of muscle mass. The laboratory method used introduces variations in Crs, an important fact considering that small increases in Crs have serious repercussion on the prognosis of patients. Efforts directed to stratify the risk of acute kidney injury (AKI) have crystallized in the RIFLE or AKIN systems, based in sequential changes in Crs or urine flow. These systems have provided a common definition of AKI and, due to their sensitivity, have meant a considerable advantage for the clinical practice but, on the other side, have introduced an uncertainty in clinical research because of potentially overestimating AKI incidence. Another significant drawback is the unavoidable period of time needed before a patient is classified, and this is perhaps the problem to be overcome in the near future.

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Section: Stratification Of Akimentioning

confidence: 99%

Estimating Kidney Function in the Critically Ill Patients

Seller-Pérez

Herrera-Gutiérrez

Maynar-Moliner

et al. 2013

Critical Care Research and Practice

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“…In our experience there are discrepancies in stratifying patients with the RIFLE system according to whether it is based on Crs or ClCr, in the sense that utilization of the latter parameter is more closely related to the prognosis. 22 It is notorious that in the surveyed ICUs, ClCr was the parameter most commonly used to estimate GF, and it is even more surprising that 70% of the Units used determinations based on 24-h urine----these data being discordant with those obtained 10 years ago in the FRAMI study, 4 where few Units made use of ClCr.…”

Section: Discussionmentioning

confidence: 94%

Variability in renal dysfunction defining criteria and detection methods in intensive care units: Are the international consensus criteria used for diagnosing renal dysfunction?

Herrera-Gutiérrez¹,

Seller-Pérez²,

Maynar-Moliner

et al. 2012

Medicina Intensiva (English Edition)

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“…rendering GFR estimation formulas based on this marker less accurate. 5 Liver failure patients and especially decompensated liver failure patients often have kidney injuries. One such specific condition is hepatorenal syndrome, characterised by a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

“…However, patients hospitalised in intensive care units (ICU) may present with conditions that modify the production and elimination of creatinine (fever, liver failure, change in water balance, rhabdomyolysis, etc.) rendering GFR estimation formulas based on this marker less accurate 5 . Liver failure patients and especially decompensated liver failure patients often have kidney injuries.…”

Section: Introductionmentioning

confidence: 99%

A single Bayesian estimator for iohexol clearance estimation in ICU, liver failure and renal transplant patients

Destère

Gandonnière

Åsberg

et al. 2022

Brit J Clinical Pharma

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Iohexol clearance has been proposed to estimate the glomerular filtration rate (GFR). A population pharmacokinetics (popPK) model was developed from heterogeneous patients. A Bayesian estimator (MAP-BE) based on a limited sampling strategy (LSS) was derived and evaluated in external patients. Methods: Full pharmacokinetic data (7-12 samples) from 172 patients receiving iohexol for measurement of their GFR (unstable and stable ICU patients, liver failure patients and kidney transplant patients) were split into development (n = 136) and validation (n = 36) datasets. A PopPK model was developed in Monolix and was used to develop MAP-BE based on LSS. Its performance for GFR estimation was evaluated in the validation set. Results: A two-compartment model with first-order elimination best described the data. The final model included the type of patients on volume of distribution (Vd), clearance and intercompartmental constants, serum creatinine on clearance and bodyweight on Vd. The best LSS included samples at 0.1-1-9 h exhibiting a relative mean prediction error (MPE) (RMSE) = À3.7% (14.3%) and better performance than the Bröchner-Mortensen formula (À3.0%/17%). Split by type of patients, the highest interindividual variability and imprecision was observed in unstable ICU patients (MPE (RMSE) = 3.7% (18.8%)) while the best performances were obtained for renal transplant patients (MPE (RMSE) = 1.0% (5.8%)). All LSS that included samples before 9 hours for the third sample were associated with an increased imprecision. Conclusion:A single MAP-BE of iohexol based on a three-sample LSS for four heterogeneous populations was developed and allowed accurate estimation of GFR in kidney transplant patients, slightly biased in stable ICU patients and slightly imprecise in unstable ICU patients.

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Discrepancies in the RIFLE classification are due to the method used to assess the level of derangement of kidney function

Cited by 7 publications

References 31 publications

Estimating Kidney Function in the Critically Ill Patients

Estimating Kidney Function in the Critically Ill Patients

Variability in renal dysfunction defining criteria and detection methods in intensive care units: Are the international consensus criteria used for diagnosing renal dysfunction?

A single Bayesian estimator for iohexol clearance estimation in ICU, liver failure and renal transplant patients

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