Mortality among Critically Ill Acute Kidney Injury Patients Stratified with RIFLE Classification

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Jais Kumar
Hassan Mumtaz
Arsh Zahoor
Naveed Sarwar
Kishore Kumar
Shahzaib Ahmad


acute kidney injury, kidney, mortality


Acute kidney injury, also referred to as AKI, is a common complication seen in critically ill patients . There has been a significant increase in the number of AKI cases over the past few decades. In order to standardize the classification of AKI, the RIFLE (Risk, Injury, Failure, Loss, End-Stage) and AKIN (AKI Network) criteria were developed.This is a prospective, observational, and longitudinal cohort study where data from all patients admitted to the hospital intensive care unit (ICU) were collected. The study duration ranged from March 2019 to September 2020. During the study period, 198 patients were admitted to the ICU. Of these, 69 were excluded while the remaining 104 patients were included in the study.About 66–67% of the total critically ill patient population admitted in the ICU suffer from some etiology related to AKI. Our study highlights the aspect in which the cases of AKI are underreported. RIFLE class R or class I is still associated with excess mortality compared with patients who maintained normal function. RIFLE is a reliable system of classification, which is well classified and indicates the immediate necessity of renal replacement therapy (RRT); the prognosis of early RRT is fairly good in critically ill patients with AKI


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1. Pickkers P, Ostermann M, Joannidis M, Zarbock A, Hoste E, Bellomo R, et al. The intensive care medicine agenda on acute kidney injury. Intensive Care Med. 2017 Sep;43(9):1198–209.
2. Hoste EAJ, Kellum JA, Selby NM, et al. Global epidemiol-ogy and outcomes of acute kidney injury. Nat Rev Nephrol. 2018;14:607–25.
3. Cerdá J, Liu KD, Cruz DN, et al. Promoting kidney function recovery in patients with AKI requiring RRT. Clin J Am Soc Nephrol. 2015;10(10):1859–67.
4. Matuszkiewicz-Rowin ́ska J, Malyszko J. Acute kidney injury, its definition, and treatment in adults: Guidelines and reality. Pol Arch Intern Med. 2020;130(12):1074–80.
5. Levi TM, de Souza SP, de Magalhães JG, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. 2013;25(4):290–6.
6. Sultana A, Faruq MO, Ahsan AA, Mallick UK, Asaduzzaman M, Islam MM. RIFLE serum creatinine and urine output criteria combined is superior to RIFLE serum creatinine criterion alone in predicting acute kidney injury (AKI) in critically ill patients: A prospective observational study. Bangladesh Crit Care J. 2020;8(1):17–23.
7. Santos E. RIFLE: Association with mortality and length of stay in critically ill acute kidney injury patients. Rev Bras Ter Intensiva. 2009;21:359–68.
8. Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med. 2017 Jan 5;376:11–20.
9. Li DH, Wald R, Blum D, et al. Predicting mortality among critically ill patients with acute kidney injury treated with renal replacement therapy: Development and validation of new pre-diction models. J Crit Care. 2020 Apr 1;56:113–19.
10. Lai TS, Shiao CC, Wang JJ, et al. Earlier versus later initiation of renal replacement therapy among critically ill patients with acute kidney injury: A systematic review and meta-analysis of randomized controlled trials. Ann Intens Care. 2017 Dec 1;7(1):38.
11. Hoste EA, Schurgers M. Epidemiology of acute kid-ney injury: How big is the problem? Crit Care Med. 2008 Apr;36(4 Suppl):S146–51.
12. Singh TB, Rathre SS, Choudhur TA, et al. Hospital acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study. Indian J Nephrol. 2013;23(1):24–9.
13. Wijewickrama ES, Ratnayake GM, Wikramartne C, et al. Incidences and clinical outcomes of acute kidney injury in ICU: A prospective observational study in Sri Lanka. BMC Res Notes. 2014;7:305–12.
14. Lerolle N, Guérot E, Faisy C, et al. Renal failure in septic shock: Predictive value of Doppler-based renal arterial resistive index. Intens Care Med. 2006;32:1553–9.
15. Akcan-Arikan A, Zappitelli M, Loftis LL, et al. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028–35.
16. Guitard J, Cointault O, Kamar N, et al. Acute renal failure following liver transplantation with induction therapy. Clin Nephrol. 2006;65:103–12.
17. Hoste E, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care. 2006;10:R73.
18. Cruz DN, Bolgan I, Perazella MA. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): Targeting the problem with the RIFLE criteria. Clin J Am Soc Nephrol. 2007;2:418–25.
19. Maccariello E, Soares M, Valente C, et al. RIFLE classification in patients with acute kidney injury in need of renal replacement therapy. Intens Care Med. 2007;33:597–605.
20. Luo X, Jiang L, Du B, Wen Y, Wang M, Xi X, et al. A com-parison of different diagnostic criteria of acute kidney injury in critically ill patients. Critical Care. 2014;18:R144.