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RIFLE classification in patients with acute kidney injury in need of renal replacement therapy

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Abstract

Objectives

To evaluate the association of RIFLE classification with the outcomes of critically ill patients with acute kidney injury (AKI) who require renal replacement therapy (RRT).

Design and setting

Prospective cohort study in the medical-surgical ICUs at three tertiary hospitals.

Patients

214 patients over 1 year (mean age 71.4 ± 15.8 years). Continuous RRT was used in 179 (84%); patients were classified as risk (25%), injury (27%), or failure (48%). Overall mortality was 76%.

Measurements and results

There were no significant differences according to RIFLE classification (risk 72%, injury 79%, failure 76%). Variables selected in multivariate analysis were: older age (OR 1.03, 95% CI 1.01–1.06), presence of comorbidity (3.15, 1.10–9.02), poor chronic health status (6.51, 1.95–21.71), number of associated organ dysfunctions (patients with one or two organ dysfunctions 5.93, 2.03–17.33; patients with three or more organ dysfunctions 26.76, 6.28–114.11), and start of RRT after the first day of ICU (2.46, 1.09–5.53). RIFLE classification was forced into the model and was not selected. However, a subgroup analysis of 150 patients who received mechanical ventilation and vasopressors found failure to be associated with increased mortality (3.58, 1.08–11.80).

Conclusions

Older age, number of organ dysfunctions, presence of comorbidities, and reduced functional capacity were the main prognostic factors. Patients who required RRT after the first day of ICU had a worse outcome. The RIFLE classification did not discriminate the prognosis in patients with AKI in need for RRT.

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Acknowledgements

This work was performed at the intensive care units of Rede D'Or de Hospitais, Rio de Janeiro, Brazil.

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Authors and Affiliations

  1. 674 Rua Jardim Botânico Sala 405, CEP 22461-000, Rio de Janeiro, Brazil

    Elizabeth Maccariello

  2. Laboratório Multidisciplinar de Pesquisa do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Elizabeth Maccariello & Eduardo Rocha

  3. Department of Nephrology, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, Brazil

    Elizabeth Maccariello

  4. NepHro Consultoria, Rio de Janeiro, Brazil

    Elizabeth Maccariello, Márcio Soares, Carla Valente, Lina Nogueira, Ricardo V. R. Valença, José E. S. Machado & Eduardo Rocha

  5. Rede D’Or de Hospitais, Rio de Janeiro, Brazil

    Elizabeth Maccariello, Carla Valente, Ricardo V. R. Valença, José E. S. Machado & Eduardo Rocha

  6. Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil

    Márcio Soares

  7. Department of Nephrology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Eduardo Rocha

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  1. Elizabeth Maccariello
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  2. Márcio Soares
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Correspondence to Elizabeth Maccariello.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-007-0536-z

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Maccariello, E., Soares, M., Valente, C. et al. RIFLE classification in patients with acute kidney injury in need of renal replacement therapy. Intensive Care Med 33, 597–605 (2007). https://doi.org/10.1007/s00134-007-0535-0

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  • DOI: https://doi.org/10.1007/s00134-007-0535-0

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