Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria

Abstract

Until recently, more than 30 different definitions of acute renal failure (ARF) had been used in the literature. This lack of a common reference point created confusion and made comparisons difficult. It also led to strong advocacy of a consensus definition. In response to the need for a common definition and classification of ARF, the Acute Dialysis Quality Initiative (ADQI) group of experts developed and published a consensus definition of ARF. This definition goes under the acronym of RIFLE to indicate that it classifies patients with renal dysfunction according to the degree of impairment into patients at risk (R), with injury (I), with failure (F), with sustained loss (L) and with end-stage (E) status in relation to their renal function. This editorial aims to summarize and interpret recent findings concerning the application of the RIFLE criteria to the assessment of the epidemiology and the prediction of the outcome of ARF.

Postępowanie w okresie okołooperacyjnym u chorych z ryzykiem wystąpienia ostrego uszkodzenia nerek, poddawanych operacjom kardiochirurgicznym

“…nefropatią pokontrastową, nefrotoksycznością leków, uogólnionym zakażeniem), do typu 1 zespołu sercowo-nerkowego [6]. Charakteryzuje się ono wzrostem osoczowego stężenia kreatyniny o 50% w stosunku do wartości wyjścio-wej w ciągu 7 dni od zakończenia zabiegu operacyjnego, a także spadkiem wskaźnika przesączania kłębuszkowego o 25% lub zmniejszeniem diurezy godzinowej poniżej 0,5 mL kg -1 przez ponad 6h (wg kryteriów Risk Injury Failure Loss End-Stage Renal Disease [RIFLE]) [7]. Alternatywne kryteria Acute Kidney Injury Network (AKIN) dopuszczają rozpoznanie CSA-AKI również na podstawie bezwzględnego wzrostu kreatyninemii o co najmniej 0,3 mg dL -1 (26,2 µmol L -1 ) w okresie 48 godzin [8,9].…”

Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure

“…Renal dysfunction in AHF patients involves complex and multifactorial mechanisms by haemodynamic (renal arterial hypoperfusion and renal venous congestion) and non‐haemodynamic factors, and these mechanisms have not been completely elucidated. Recent studies have suggested that a WRF has not been associated with a poor outcome in some patients, thereby indicating the need to redefine a WRF in AHF patients 3, 4. AHF patients sometimes have acute renal failure on admission, so patients not having WRF (defined as an increase <0.3 mg/dL in the serum creatinine level vs. the value on admission) might include those who already have acute renal failure on admission.…”

Epidemiology, Clinical Characteristics and Outcome of Acute Kidney Injury in Intensive Care Units of Alexandria University Hospitals

“…These criteria have been validated in several clinical settings and shown to correlate with important outcomes such as need for renal replacement therapy (RRT), length of hospital stay, and mortality. In fact, the RIFlE criteria are now well recognized and have been cited in more than 150 manuscripts [5].…”