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Open Access 01-02-2011 | Research

Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery

Authors: Lars Englberger, Rakesh M Suri, Zhuo Li, Edward T Casey, Richard C Daly, Joseph A Dearani, Hartzell V Schaff

Published in: Critical Care | Issue 1/2011

Abstract

Introduction

The RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification for acute kidney injury (AKI) was recently modified by the Acute Kidney Injury Network (AKIN). The two definition systems differ in several aspects, and it is not clearly determined which has the better clinical accuracy.

Methods

In a retrospective observational study we investigated 4,836 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from 2005 to 2007 at Mayo Clinic, Rochester, MN, USA. AKI was defined by RIFLE and AKIN criteria.

Results

Significantly more patients were diagnosed as AKI by AKIN (26.3%) than by RIFLE (18.9%) criteria (P < 0.0001). Both definitions showed excellent association to outcome variables with worse outcome by increased severity of AKI (P < 0.001, all variables). Mortality was increased with an odds ratio (OR) of 4.5 (95% CI 3.6 to 5.6) for one class increase by RIFLE and an OR of 5.3 (95% CI 4.3 to 6.6) for one stage increase by AKIN. The multivariate model showed lower predictive ability of RIFLE for mortality. Patients classified as AKI in one but not in the other definition set were predominantly staged in the lowest AKI severity class (9.6% of patients in AKIN stage 1, 2.3% of patients in RIFLE class R). Potential misclassification of AKI is higher in AKIN, which is related to moving the 48-hour diagnostic window applied in AKIN criteria only. The greatest disagreement between both definition sets could be detected in patients with initial postoperative decrease of serum creatinine.

Conclusions

Modification of RIFLE by staging of all patients with acute renal replacement therapy (RRT) in the failure class F may improve predictive value. AKIN applied in patients undergoing cardiac surgery without correction of serum creatinine for fluid balance may lead to over-diagnosis of AKI (poor positive predictive value). Balancing limitations of both definition sets of AKI, we suggest application of the RIFLE criteria in patients undergoing cardiac surgery.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup: Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004, 8: R204-R212. 10.1186/cc2872.PubMedPubMedCentralCrossRef

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007, 11: R31-10.1186/cc5713.PubMedPubMedCentralCrossRef

Levey AS, Greene T, Kusek JW, Beck GL, MDRD Study Group: A simplified equation to predict glomerular filtration rate from serum creatinine [Abstract]. J Am Soc Nephrol. 2000, 11: AO828-

Lopes JA, Fernandes P, Jorge S, Gonçalves S, Alvarez A, Costa e Silva Z, França C, Prata MM: Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care. 2008, 12: R110-10.1186/cc6997.PubMedPubMedCentralCrossRef

Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committee: A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008, 23: 1569-1574. 10.1093/ndt/gfn009.PubMedCrossRef

Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG: Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009, 35: 1692-1702. 10.1007/s00134-009-1530-4.PubMedCrossRef

Haase M, Bellomo R, Matalanis G, Calzavacca P, Dragun D, Haase-Fielitz A: A Comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: A prospective cohort study. J Thorac Cardiovasc Surg. 2009, 138: 1370-1376. 10.1016/j.jtcvs.2009.07.007.PubMedCrossRef

Lassnigg A, Schmid ER, Hiesmayr M, Falk C, Druml W, Bauer P, Schmidlin D: Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure?. Crit Care Med. 2008, 36: 1129-1137. 10.1097/CCM.0b013e318169181a.PubMedCrossRef

Yan X, Jia S, Meng X, Dong P, Jia M, Wan J, Hou X: Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria. Eur J Cardiothorac Surg. 2010, 37: 334-338.PubMed

10.

Chang CH, Lin CY, Tian YC, Jenq CC, Chang MY, Chen YC, Fang JT, Yang CW: Acute kidney injury classification: comparison of AKIN and RIFLE criteria. Shock. 2010, 33: 247-252. 10.1097/SHK.0b013e3181b2fe0c.PubMedCrossRef

11.

Cruz DN, Ricci Z, Ronco C: Clinical review: RIFLE and AKIN--time for reappraisal. Crit Care. 2009, 13: 211-10.1186/cc7759.PubMedPubMedCentralCrossRef

12.

Bagshaw SM, Uchino S, Cruz D, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van Straaten HM, Ronco C, Kellum JA, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury. Nephrol Dial Transplant. 2009, 24: 2739-2744. 10.1093/ndt/gfp159.PubMedCrossRef

13.

Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006, 10: R73-10.1186/cc4915.PubMedPubMedCentralCrossRef

14.

Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C: An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006, 34: 1913-1917. 10.1097/01.CCM.0000224227.70642.4F.PubMedCrossRef

15.

Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettilä V: Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg. 2006, 81: 542-546. 10.1016/j.athoracsur.2005.07.047.PubMedCrossRef

16.

Ostermann M, Chang RW: Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007, 35: 1837-1843. 10.1097/01.CCM.0000277041.13090.0A.PubMedCrossRef

17.

Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA: Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med. 2008, 36: 1397-1403. 10.1097/CCM.0b013e318168fbe0.PubMedCrossRef

18.

Karkouti K, Wijeysundera DN, Yau TM, Callum JL, Cheng DC, Crowther M, Dupuis JY, Fremes SE, Kent B, Laflamme C, Lamy A, Legare JF, Mazer CD, McCluskey SA, Rubens FD, Sawchuk C, Beattie WS: Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation. 2009, 119: 495-502. 10.1161/CIRCULATIONAHA.108.786913.PubMedCrossRef

19.

Bihorac A, Yavas S, Subbiah S, Hobson CE, Schold JD, Gabrielli A, Layon AJ, Segal MS: Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg. 2009, 249: 851-858. 10.1097/SLA.0b013e3181a40a0b.PubMedCrossRef

20.

Ostermann M, Chang R, Riyadh ICU Program Users Group: Correlation between the AKI classification and outcome. Crit Care. 2008, 12: R144-10.1186/cc7123.PubMedPubMedCentralCrossRef

21.

Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML: Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med. 2009, 37: 2552-2558. 10.1097/CCM.0b013e3181a5906f.PubMedCrossRef

22.

Van Biesen W, Lameire N, Vanholder R, Mehta R: Relation between acute kidney injury and multiple-organ failure: the chicken and the egg question. Crit Care Med. 2007, 35: 316-317. 10.1097/01.CCM.0000251987.16415.01.PubMedCrossRef

23.

Hoste EA, Cruz DN, Davenport A, Mehta RL, Piccinni P, Tetta C, Viscovo G, Ronco C: The epidemiology of cardiac surgery-associated acute kidney injury. Int J Artif Organs. 2008, 31: 158-165.PubMed

24.

Van Biesen W, Vanholder R, Lameire N: Defining acute renal failure: RIFLE and beyond. Clin J Am Soc Nephrol. 2006, 1: 1314-1319. 10.2215/CJN.02070606.PubMedCrossRef

25.

Delanaye P, Cohen EP: Formula-based estimates of the GFR: equations variable and uncertain. Nephron Clin Pract. 2008, 110: c48-53. 10.1159/000151436.PubMedCrossRef

26.

Pickering JW, Endre ZH: GFR shot by RIFLE: errors in staging acute kidney injury. Lancet. 2009, 373: 1318-1319. 10.1016/S0140-6736(09)60751-0.PubMedCrossRef

27.

Englberger L, Suri RM, Schaff HV: RIFLE is not RIFLE : on the comparability of results. Crit Care. 2009, 13: 429-10.1186/cc8175.PubMedPubMedCentralCrossRef

28.

Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL: Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol. 2008, 3: 948-954. 10.2215/CJN.05431207.PubMedPubMedCentralCrossRef

29.

Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, for the Program to Improve Care in Acute Renal Disease (PICARD) study: Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care. 2010, 14: R82-10.1186/cc9004.PubMedPubMedCentralCrossRef

30.

Mehta RL: From acute renal failure to acute kidney injury: emerging concepts. Crit Care Med. 2008, 36: 1641-1642. 10.1097/CCM.0b013e3181701481.PubMedCrossRef

Title: Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery
Authors: Lars Englberger
Rakesh M Suri
Zhuo Li
Edward T Casey
Richard C Daly
Joseph A Dearani
Hartzell V Schaff
Publication date: 01-02-2011
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2011
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc9960

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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