Evaluation of the prognostic value of the risk, injury, failure, loss and end‐stage renal failure (RIFLE) criteria for acute kidney injury

Valdivieso, José Ramón Pérez; Bes–Rastrollo, Maira; Monedero, Pablo; Irala, Jokin de; Lavilla, Francisco Javier

doi:10.1111/j.1440-1797.2008.00950.x

Cited by 23 publications

(19 citation statements)

References 29 publications

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“…RIFLE class L was also associated with higher 1-year mortality in our study, which is similar to previous findings [27,49,50]. Age, severe RIFLE class, etiology of AKI and prior CKD have been shown to be independent factors for higher risk of 1-year mortality in several studies [22,27,39] and in an extensive meta-analysis [29]. In the present study, RIFLE class L, older age and prior CKD - but not etiology of AKI - were identified as independent risk factors for 1-year mortality.…”

Section: Discussionsupporting

confidence: 83%

“…Oliguria was associated with hospital death in our study and in others [48], but we did not found an association with 1- and 10-year mortalities. RIFLE class L was also associated with higher 1-year mortality in our study, which is similar to previous findings [27,49,50]. Age, severe RIFLE class, etiology of AKI and prior CKD have been shown to be independent factors for higher risk of 1-year mortality in several studies [22,27,39] and in an extensive meta-analysis [29].…”

Section: Discussionsupporting

confidence: 82%

“…Few studies [21,22] have focused on this specific population, as most have included ICU patients, either exclusively [6,9] or as part of the general hospital population [4,23,24,25,26,27,28]. Moreover, previous studies that examined ≥10 years of survival in hospitalized patients with AKI are sparse and none reflect on whether patients who were treated in ICU at any time during admission were excluded [29] and such studies were very limited in general population [30].…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

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Background: Epidemiological studies of acute kidney injury (AKI) have focused on patients admitted to intensive care units (ICUs), and several have studied hospitalized non-ICU patients, but analysis of patients referred to Nephrology is sparse. We analyzed factors associated with short- and long-term morbimortality among hospitalized non-ICU patients with AKI who were referred to Nephrology. Methods: A retrospective study with data prospectively collected from 170 non-ICU patients, with referral to the Nephrology Unit, recruited over a 4-year period, was performed. AKI was classified according to the criteria based on risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE). Risk factors that could influence prognosis of AKI and long-term mortality were analyzed at admission. Early on, 1- and 10-year mortalities were correlated with AKI RIFLE class, clinical and demographic characteristics. Results: Most patients were >65 years, with multiple comorbidities and frequent drug intake history. Median Charlson score was 6. Twenty-five percent of patients with previously unknown chronic kidney disease (CKD) were diagnosed with CKD during the study. Dialysis was required in 13.5% of patients. Hospital deaths were 22.4% and significantly associated with older age, RIFLE class L, higher peak serum creatinine, oliguria and decreased serum albumin levels. One-year (38.8%) and 10-year (68.8%) mortalities were significantly associated with age, prior cardiovascular disease, prior CKD and RIFLE class L. According to the Cox proportional hazard model, age, prior CKD and RIFLE class L were independent risk factors of death at 1 and 10 years. Conclusions: AKI in hospitalized non-ICU patients is associated with high early and late mortality. This study increases our understanding of AKI among this specific population and can improve their management.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

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“…Consequently, they recommended that an estimated baseline creatinine be calculated using the Modification of Diet in Renal Disease (MDRD) formula (11) with an assumed GFR for all patients between 75 and 100 ml/min. As a tool for post hoc analysis in research studies, this back-calculation method has become widespread, with most studies adopting 75 ml/min (5,8,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). A few epidemiologic studies have used an estimated baseline for all of their patients (e.g., those using the Australian and New Zealand Intensive Care Society database (5,(12)(13)(14)), whereas in other studies the proportion of patients for whom a baseline is estimated by back-calculation is as low as 7% (19).…”

mentioning

confidence: 99%

Back-Calculating Baseline Creatinine with MDRD Misclassifies Acute Kidney Injury in the Intensive Care Unit

Pickering

Endre

2010

Clinical Journal of the American Society of Nephrology

141

120

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Background and objectives: The purpose of this study was to assess the viability of back-calculation with the Modification of Diet in Renal Disease (MDRD) formula to determine baseline creatinine on the basis of acute kidney injury (AKI) metrics, RIFLE criteria, and Acute Kidney Injury Network (AKIN) criteria for the purpose of clinical trial outcomes or epidemiology.Design, setting, participants, & measurements: This study was a retrospective analysis of prospectively collected data from patients with measured baseline creatinines before entry to the intensive care unit (ICU). The AKI status was determined using five different baseline creatinines: the measured creatinine (the standard) and an estimated creatinine determined by back-calculation using MDRD assuming a GFR of 75 ml/min (epCr 75 ), 100 ml/min (epCr 100 ), randomly generating a value on a lognormal curve (epCr Rnd ), and choosing the lowest creatinine value within the first week in the ICU (epCr low ). A subgroup of patients without chronic kidney disease (CKD) was similarly analyzed.Results: Of 224 patients, 70 (31%) had AKI according to RIFLE and 93 (42%) according to AKIN. The epCr 75 and epCr 100 distributions greatly overestimated the proportion with AKI. The epCr low overestimated AKI according to AKIN but correctly estimated AKI according to RIFLE. The mean of 1000 epCr Rnd distributions correctly estimated AKI according to RIFLE and AKIN. Each estimated distribution performed better in the non-CKD population with the exception of epCr Rnd . However, only the epCr low distribution accurately determined the proportion with AKI.Conclusions: A measured rather than estimated value should be used for baseline creatinine in trials or epidemiologic studies of AKI.

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“…In 2010, Zavadá and colleagues introduced the Pittsburgh Linear Three Variables (PLTV) formula, which uses the same anthropometric variables as the MDRD equation and has shown promising results (8). To estimate the bSCr with all these formulae, we assume that the GFR is equivalent to a standard GFR of 75 ml/min per 1.73 m 2 (1,4,9,10). However, use of a standard GFR is not appropriate because there is high variability in the GFR within a given population due to age or gender.…”

Section: Introductionmentioning

confidence: 99%

Serum Creatinine Back-Estimation in Cardiac Surgery Patients

Bernardi¹,

Schmidlin

Ristl

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives A knowledge of baseline serum creatinine (bSCr) is mandatory for diagnosing and staging AKI. With often missing values, bSCr is estimated by back-calculation using several equations designed for the estimation of GFR, assuming a "true" GFR of 75 ml/min per 1.73 m 2 . Using a data set from a large cardiac surgery cohort, we tested the appropriateness of such an approach and compared estimated and measured bSCr. Moreover, we designed a novel data-driven model (estimated serum creatinine [eSCr]) for estimating bSCr. Finally, we analyzed the extent of AKI and mortality rate misclassifications.Design, setting, participants, & measurements Data for 8024 patients (2833 women) in our cardiac surgery center were included from 1997 to 2008. Measured and estimated bSCr were plotted against age for men and women. Patients were classified to AKI stages defined by the Kidney Disease Improving Global Outcomes (KDIGO) group. Results were compared with data from another cardiac surgery center in Zurich, Switzerland.Results The Modification of Diet in Renal Disease and the Chronic Kidney Disease Epidemiology Collaboration formulae describe higher estimated bSCr values in younger patients, but lower values in older patients compared with the measured bSCr values in both centers. The Pittsburgh Linear Three Variables formula correctly describes the increasing bSCr with age, however, it underestimates the overall bSCr level, being in the range of the 25% quantile of the measured values. Our eSCr model estimated measured bSCr best. AKI stage 1 classification using all formulae, including our eSCr model, was incorrect in 53%-80% of patients in Vienna and in 74%-91% in Zurich; AKI severity (according to KDIGO stages) and also mortality were overestimated. Mortality rate was higher among patients falsely classified into higher KDIGO stages by estimated bSCr.Conclusions bSCr values back-estimated using currently available eGFR formulae are inaccurate and cannot correctly classify AKI stages. Our model eSCr improves the prediction of AKI but to a still inadequate extent.

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Evaluation of the prognostic value of the risk, injury, failure, loss and end‐stage renal failure (RIFLE) criteria for acute kidney injury

Cited by 23 publications

References 29 publications

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Back-Calculating Baseline Creatinine with MDRD Misclassifies Acute Kidney Injury in the Intensive Care Unit

Serum Creatinine Back-Estimation in Cardiac Surgery Patients

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