Advanced age affects the outcome-predictive power of RIFLE classification in geriatric patients with acute kidney injury

Abstract

The RIFLE (risk, injury, failure, loss, and end-stage) classification is widely used to gauge the severity of acute kidney injury, but its efficacy has not been formally tested in geriatric patients. To correct this we conducted a prospective observational study in a multicenter cohort of 3931 elderly patients (65 years of age or older) who developed acute kidney injury in accordance with the RIFLE creatinine criteria after major surgery. We studied the predictive power of the RIFLE classification for in-hospital mortality and investigated the potential interaction between age and RIFLE classification. In general, the survivors were significantly younger than the nonsurvivors and more likely to have hypertension. In patients 76 years of age and younger, RIFLE-R, -I, or -F classifications were significantly associated with increased hospital mortality in a stepwise manner. There was no significant difference, however, in hospital mortality in those over 76 years of age between patients with RIFLE-R and RIFLE-I, although RIFLE-F patients had significantly higher mortality than both groups. Thus, the less severe categorizations of acute kidney injury per RIFLE classification may not truly reflect the adverse impact on elderly patients.

Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome

“…[3][4][5]8,9,12 We found that 27% of geriatric patients had AKI and most of them had AKI stage 1, in agreement with the literature. 15,16 The in-ICU mortality of geriatric AKI patients (48.1%) was higher than the other studies (16%-40%). [3][4][5]16 However, these studies also included elderly patients not only in ICUs but also in general wards of the hospital.…”

“…This is due to many reasons, including elderly are more likely to have renal structural decline and multiple comorbidities. 3,8,9,12,14,15 Previous studies reported the incidence of AKI among geriatric patients ranged from 22% to 40%, with most patients having stage 1 disease. [3][4][5]8,9,12 We found that 27% of geriatric patients had AKI and most of them had AKI stage 1, in agreement with the literature.…”

Impact of Body Mass on Outcomes of Geriatric Postoperative Acute Kidney Injury Patients

“…Another sensitivity analysis excluding these patients resulted essentially similar (detailed in result section). Finally, AKI severity could not be adjusted owing to the absence of urine output data in our database, so AKI was coded as present or not (15,16,35). As the current study is the retrospective analysis of our postoperative patients' registry, applications beyond ethnicity/age-matched cohorts could be questionable.…”

“…Renal Failure) database (15). Participating centers consist of National Taiwan University Hospital and its regional branch hospitals.…”

The association between the duration of postoperative acute kidney injury and in-hospital mortality in critically ill patients after non-cardiac surgery: an observational cohort study

“…13,22 AKI has been well described in geriatric population, and an increased incidence of AKI becomes higher than previous studies (2-25%). 24 The proportion of AKI in these patients is 33.6% due to the use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) prior to surgical intervention. The association between preoperative management of ACEIs and/or ARBs and cardiovascular surgery should increase the incidence of AKI $27.2%.…”