Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 4/2014

Open Access 01-08-2014 | Research

A comparison of different diagnostic criteria of acute kidney injury in critically ill patients

Authors: Xuying Luo, Li Jiang, Bin Du, Ying Wen, Meiping Wang, Xiuming Xi, The Beijing Acute Kidney Injury Trial (BAKIT) workgroup

Published in: Critical Care | Issue 4/2014

Login to get access

Abstract

Introduction

Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) proposed a new definition and classification of acute kidney injury (AKI) on the basis of the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage renal failure) and AKIN (Acute Kidney Injury Network) criteria, but comparisons of the three criteria in critically ill patients are rare.

Methods

We prospectively analyzed a clinical database of 3,107 adult patients who were consecutively admitted to one of 30 intensive care units of 28 tertiary hospitals in Beijing from 1 March to 31 August 2012. AKI was defined by the RIFLE, AKIN, and KDIGO criteria. Receiver operating curves were used to compare the predictive ability for mortality, and logistic regression analysis was used for the calculation of odds ratios and 95% confidence intervals.

Results

The rates of incidence of AKI using the RIFLE, AKIN, and KDIGO criteria were 46.9%, 38.4%, and 51%, respectively. KDIGO identified more patients than did RIFLE (51% versus 46.9%, P = 0.001) and AKIN (51% versus 38.4%, P <0.001). Compared with patients without AKI, in-hospital mortality was significantly higher for those diagnosed as AKI by using the RIFLE (27.8% versus 7%, P <0.001), AKIN (32.2% versus 7.1%, P <0.001), and KDIGO (27.4% versus 5.6%, P <0.001) criteria, respectively. There was no difference in AKI-related mortality between RIFLE and KDIGO (27.8% versus 27.4%, P = 0.815), but there was significant difference between AKIN and KDIGO (32.2% versus 27.4%, P = 0.006). The areas under the receiver operator characteristic curve for in-hospital mortality were 0.738 (P <0.001) for RIFLE, 0.746 (P <0.001) for AKIN, and 0.757 (P <0.001) for KDIGO. KDIGO was more predictive than RIFLE for in-hospital mortality (P <0.001), but there was no difference between KDIGO and AKIN (P = 0.12).

Conclusions

A higher incidence of AKI was diagnosed according to KDIGO criteria. Patients diagnosed as AKI had a significantly higher in-hospital mortality than non-AKI patients, no matter which criteria were used. Compared with the RIFLE criteria, KDIGO was more predictive for in-hospital mortality, but there was no significant difference between AKIN and KDIGO.
Appendix
Available only for authorised users
Literature
1.
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.CrossRefPubMed
2.
Bagshaw SM, George C, Dinu I, Bellomo R: A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008, 23: 1203-1210.CrossRefPubMed
3.
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.CrossRefPubMed
4.
Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, Haapio M, Inkinen O, Parviainen I, Suojaranta-Ylinen R, Laurila JJ, Tenhunen J, Reinikainen M, Ala-Kokko T, Ruokonen E, Kuitunen A, Pettilä V, FINNAKI Study Group: Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med. 2013, 39: 420-428.CrossRefPubMed
5.
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-PubMedCentralCrossRefPubMed
6.
Zhou J, Yang L, Zhang K, Liu Y, Fu P: Risk factors for the prognosis of acute kidney injury under the Acute Kidney Injury Network definition: A retrospective, multicenter study in critically ill patients. Nephrology. 2012, 17: 330-337.CrossRefPubMed
7.
Wen Y, Jiang L, Xu Y, Qian CY, Li SS, Qin TH, Chen EZ, Lin JD, Ai YH, Wu DW, Wang YS, Sun RH, Hu ZJ, Cao XY, Zhou FC, He ZY, Zhou LH, An YZ, Kang Y, Ma XC, Yu XY, Zhao MY, Xi XM, DU B: Prevalence, risk factors, clinical course, and outcome of acute kidney injury in Chinese Intensive Care Units: a prospective cohort study. Chin Med J. 2013, 126: 4409-4416.PubMed
8.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup: 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.PubMedCentralCrossRefPubMed
9.
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-PubMedCentralCrossRefPubMed
10.
Lin CY, Chen YC, Tsai FC, Tian YC, Jenq CC, Fang JT, Yang CW: RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrol Dial Transplant. 2006, 21: 2867-2873.CrossRefPubMed
11.
Lopes JA, Jorge S, Neves FC, Caneira M, da Costa AG, Ferreira AC, Prata MM: An assessment of the rifle criteria for acute renal failure in severely burned patients. Nephrol Dial Transplant. 2007, 22: 285-CrossRefPubMed
12.
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.CrossRefPubMed
13.
Ostermann M, Chang RW: Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007, 35: 1837-1843.CrossRefPubMed
14.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007, 11: R31-PubMedCentralCrossRefPubMed
15.
Disease K: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group: KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl. 2012, 2: 1-138.CrossRef
16.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure, On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996, 22: 707-710.CrossRefPubMed
17.
Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, Xu JS, Huang SM, Wang LN, Huang W, Wang M, Xu GB, Wang HY: Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol. 2006, 17: 2937-2944.CrossRefPubMed
18.
DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988, 44: 837-845.CrossRefPubMed
19.
Bastin AJ, Ostermann M, Slack AJ, Diller GP, Finney SJ, Evans TW: Acute kidney injury after cardiac surgery according to Risk/Injury/Failure/Loss/End-stage, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes classifications. J Crit Care. 2013, 28: 389-396.CrossRefPubMed
20.
Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS: Incidence, Outcomes, and Comparisons across Definitions of AKI in Hospitalized Individuals. Clin J Am Soc Nephrol. 2014, 9: 12-20.PubMedCentralCrossRefPubMed
21.
Fujii T, Uchino S, Takinami M, Bellomo R: Validation of the Kidney Disease Improving Global Outcomes Criteria for AKI and Comparison of Three Criteria in Hospitalized Patients. Clin J Am Soc Nephrol. 2014, in print
22.
Srisawat N, Kellum JA: Acute kidney injury: definition, epidemiology, and outcome. Curr Opin Crit Care. 2011, 17: 548-555.CrossRefPubMed
23.
Bagshaw SM: Acute kidney injury: diagnosis and classification of AKI: AKIN or RIFLE?. Nat Rev Nephrol. 2010, 6: 71-73.CrossRefPubMed
24.
Siew ED, Matheny ME, Ikizler TA, Lewis JB, Miller RA, Waitman LR, Go AS, Parikh CR, Peterson JF: Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury. Kidney Int. 2010, 77: 536-542.PubMedCentralCrossRefPubMed
25.
26.
Mandelbaum T, Scott DJ, Lee J, Mark RG, Malhotra A, Waikar SS, Howell MD, Talmor D: Outcome of Critically ill Patients with Acute Kidney Injury using the AKIN Criteria. Crit Care Med. 2011, 39: 2659-2664.PubMedCentralPubMed
27.
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
28.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005, 16: 3365-3370.CrossRefPubMed
29.
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.CrossRefPubMed
30.
Wilson FP, Sheehan JM, Mariani LH, Berns JS: Creatinine generation is reduced in patients requiring continuous venovenous hemodialysis and independently predicts mortality. Nephrol Dial Transplant. 2012, 27: 4088-4494.PubMedCentralCrossRefPubMed
31.
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: 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.CrossRefPubMed
32.
Macedo E, Malhotra R, Claure-Del Granado R, Fedullo P, Mehta RL: Defining urine output criterion for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2011, 26: 509-515.PubMedCentralCrossRefPubMed
Metadata
Title
A comparison of different diagnostic criteria of acute kidney injury in critically ill patients
Authors
Xuying Luo
Li Jiang
Bin Du
Ying Wen
Meiping Wang
Xiuming Xi
The Beijing Acute Kidney Injury Trial (BAKIT) workgroup
Publication date
01-08-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13977

Other articles of this Issue 4/2014

Critical Care 4/2014 Go to the issue

Research

Purified cell wall from the probiotic bacterium Lactobacillus gasseriactivates systemic inflammation and, at higher doses, produces lethality in a rat model

Research

Variability of linezolid concentrations after standard dosing in critically ill patients: a prospective observational study

Research

Early mobilization on continuous renal replacement therapy is safe and may improve filter life

Research

Use of 1H-nuclear magnetic resonance to screen a set of biomarkers for monitoring metabolic disturbances in severe burn patients

Research

Emergent severe acute respiratory distress syndrome caused by adenovirus type 55 in immunocompetent adults in 2013: a prospective observational study

Research

Plasma and urine neutrophil gelatinase-associated lipocalin in the diagnosis of new onset acute kidney injury in critically ill patients