Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Lin, Chan‐Yu; Chen, Yung‐Chang

doi:10.5492/wjccm.v1.i2.40

Cited by 57 publications

(47 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…Acute kidney injury that developed during ECMO could be attributed to multiple factors such as sepsis, low cardiac output syndrome, exposure to nephrotoxic agents, and high intrathoracic pressures. 36 Previous studies have shown that the mortality associated with acute kidney injury was still high 37 and that the prognosis was related to age, acute physiology, and chronic health status.38 Therefore, it is necessary to screen for acute kidney injury throughout the time course to improve outcomes in this at-risk adult population. Finally, renal failure and the other major complications (gastrointestinal bleeding, intracranial bleeding and ischemic stroke) may all have intravascular origins in common.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults

et al. 2016

View full text Add to dashboard Cite

As a result of many "miraculous" experiences, intensive care facilities everywhere in Taiwan are adopting ECMO technology. 13,14 The Taiwan National Health Insurance (NHI) initiated reimbursement for the high costs of ECMO therapy in 2002, further supporting its rapidly expanding implementation in the years since. The criteria for instituting ECMO in adult patients included cardiogenic shock of various origins, respiratory failure (defined as Pao 2 <60 mm Hg under 100% Fio 2 , CO 2 retention, or a bridge to lung transplantation) resulting from infectious or noninfectious processes, airway injury, and hypothermia (core temperature ≤30°C).15 ECMO is most used as a last resort for patients with severe refractory shock. The Taiwan NHI Background-Extracorporeal membrane oxygenation (ECMO) provides circulatory and respiratory support for patients with severe acute cardiopulmonary failure. The objective of this study was to examine the survival outcomes for patients who received ECMO. Methods and Results-Adult patients who received ECMO from September 1, 2002, to December 31, 2012 from the Taiwan National Health Insurance Database associated with coronary artery bypass graft surgery, myocardial infarction/cardiogenic shock, injury, and infection/septic shock. A Cox regression model was used to determine hazard ratios and to compare 30-day and 1-year survival rates with the myocardial infarction/cardiogenic shock group used as the reference. The mean±SD age of the 4227-patient cohort was 57±17 years, and 72% were male. The overall mortalities were 59.8% and 76.5% at 1 month and 1 year. Survival statistics deteriorated sharply when ECMO was required for >3 days. Acute (30-day) survival was more favorable in the infection/septic shock (n=1076; hazard ratio, 0.61; 95% confidence interval, 0.55-0.67), coronary artery bypass graft surgery (n=1077; hazard ratio, 0.68; 95% confidence interval, 0.61-0.75), and injury (n=369, hazard ratio, 0.82; 95% confidence interval, 0.70-0.95) groups. The extended survival rapidly approached an asymptote near 20% for the infection/septic shock, myocardial infarction/cardiogenic shock (n=1705), and coronary artery bypass graft surgery groups. The pattern of survival for the injury group was somewhat better, exceeding 30% at year-end. Conclusions-Regardless of initial pathology, patients requiring ECMO were critically ill with similar guarded prognoses.Those in the trauma group had somewhat better outcomes. Determining the efficacy and cost-effectiveness of ECMO should be a critical future goal. Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.Received August 22, 2015; accepted April 19, 2016. claims database contains extensive clinical data obtained during the roll out of this therapeutic modality and thus allows the study of the outcomes of patients on ECMO. Despite the efficacy of prompt ECMO support as an acute lifesaving strategy in cardiovascular emergencies, the overall mortality associated with cardiogenic shock...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults

et al. 2016

View full text Add to dashboard Cite

show abstract

“…El criterio RIFLE fue publicado por el Acute Dialysis Quality Initiative group en 2004 (17) con la finalidad de estandarizar las definiciones de IRA. Posteriormente, en 2007, surgió la clasificación AKIN y ambas han probado su utilidad en determinar la severidad del daño renal en pacientes críticos (22,23) . Por otra parte, la clasificación AKIN no mejoró la sensibilidad ni la habilidad para predecir resultados en pacientes graves.…”

Section: Discussionunclassified

Incidencia acumulada de insuficiencia renal aguda en el posoperatorio de cirugía cardíaca

2018

Rev.Urug.Cardiol.

View full text Add to dashboard Cite

Introducción: la insuficiencia renal aguda (IRA) constituye una causa frecuente de morbimortalidad en el posoperatorio de cirugía cardíaca, con incidencia variable según la definición utilizada y los factores derivados del paciente y del procedimiento quirúrgico. Objetivo: los objetivos de este artículo fueron determinar la incidencia de IRA en un centro de cirugía cardíaca, la presencia de predictores y su asociación con mortalidad quirúrgica. Métodos: estudio prospectivo y observacional con elementos analíticos. Se incluyeron todos los pacientes con función renal normal y sin antecedentes de enfermedad renal sometidos a cirugía cardíaca en el período julio 2014 -julio 2015. Se determinó la creatininemia basal y a las 24 y 48 horas de la cirugía. La IRA fue definida utilizando el criterio RIFLE. Se valoró mortalidad quirúrgica y se analizaron variables pre e intraoperatorias como predictoras de desarrollo de IRA utilizando análisis uni y multivariado. Resultados: cumplieron los criterios de inclusión 400 pacientes. La incidencia de IRA por criterio RIFLE fue 10,3% (IC95% 8,7-11,8); la mortalidad quirúrgica en este grupo alcanzó 19,5%, mientras que en los controles fue 1,9%. Las variables asociadas al desarrollo de IRA fueron EuroSCORE más elevado, cirugía combinada, uso de circulación extracorpórea (CEC) y clampeo aórtico. La cirugía de revascularización miocárdica (CRM) presentó una asociación inversa con la aparición de IRA y constituyó un predictor independiente en el análisis multivariado. La presencia de IRA fue un predictor independiente de mortalidad quirúrgica. Conclusiones: la incidencia de IRA es frecuente en el posoperatorio de cirugía cardíaca y se encuentra dentro de los valores internacionales. Su presencia implica mayor mortalidad quirúrgica.

show abstract

“…Clinical outcomes—Clinical outcomes in the FISSH pilot trial will reflect outcomes for the main trial which will include: hospital mortality, RRT use for AKI during 30-day period postrandomisation (including continuous renal replacement therapy or conventional haemodialysis), proportion of patients with RIFLE stage renal failure, 11 30-day mortality, ICU and hospital length of stay (censored at 30 days), ventilator-free days in the first 30 days postrandomisation and safety outcomes (acidosis and electrolyte imbalance postrandomisation).…”

Section: Methodsmentioning

confidence: 99%

Fluids in Sepsis and Septic Shock (FISSH): protocol for a pilot randomised controlled trial

et al. 2017

View full text Add to dashboard Cite

IntroductionObservational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock.Methods and analysisThis is a randomised, concealed, blinded parallel-group multicentre pilot trial. We will include adult critically ill patients with septic shock, defined as ongoing hypotension despite 1 L of fluid, or a serum lactate >4 mmol/L, who are within 6 hours of hospital presentation or rapid response team activation. We will exclude patients if they have an aetiology of shock other than sepsis, if they have acute burn injury, elevated intracranial pressure, intent to withdraw life support or previous enrolment in this or a competing trial. Following informed consent, patients will be randomised to a low chloride fluid strategy or a high chloride fluid strategy for the duration of their ICU stay or until 30 days postrandomisation. Clinicians, patients, families and research staff will be blinded. The primary outcome for this trial will be feasibility, assessed by consent rate, recruitment success and protocol adherence. Patient-important clinical outcomes include mortality, receipt of renal replacement therapy, intensive care unit and hospital lengths of stay and surrogate outcomes of incidence of acidosis, hyperkalaemia and acute kidney injury.Ethics and disseminationThis pilot trial will test the feasibility of conducting the main trial, which will examine the effect of high versus low chloride fluids in patients with septic shock on patient-important outcomes.Trial registration numberNCT02748382, registered 8 April 2016.Protocol date1 July 2016.

show abstract

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Cited by 57 publications

References 55 publications

Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults

Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults

Incidencia acumulada de insuficiencia renal aguda en el posoperatorio de cirugía cardíaca

Fluids in Sepsis and Septic Shock (FISSH): protocol for a pilot randomised controlled trial

Contact Info

Product

Resources

About