Title: Clinical Profile of Acute Kidney Injury: A Comparative Study of Rifle Vs Akin Criteria

Authors: Dr Saurabh Sharma, Dr Vedavathi R

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i12.19

Abstract

Acute kidney injury (AKI) is a worldwide clinical dilemma encountered in critically ill patients and characteristically portends an increase in morbidity and mortality.

Objective: To study prospectively the clinical spectrum of AKI and assessment of RIFLE Criteria vs AKIN Criteria in terms of clinical course, risk stratification and prognosis among patients with AKI in ICUs and emergency.

Methodology: Prospective clinical descriptive study was done in 100 patients admitted in various ICUs (Intensive Care Unit) and Emergency Ward in Kempegowda institute of Medical Science. According to patients co morbidities and underlying pathology patients were followed clinically and by serial biochemical tests and were started on conservative treatment, if indicated patients were taken for hemodialysis.

Results: In this study out of 100 patients 48 required ventilator support and inotropic support and 30 patients underwent dialysis. Overall 49 patients died amounting to 49% mortality. On RIFLE staging mortality in patients with AKI stage failure was 56.2%, injury was 44.4%, and risk is 53.8% indicating that there was no significant difference in mortality by RIFLE stage.

Conclusion: The AKIN criteria improve the sensitivity of the Acute Kidney Injury (AKI) diagnosis over the RIFLE Criteria. The AKIN Criteria do not improve on the ability of the RIFLE criteria in predicting in hospital mortality of critically ill Patients.

References

1.      Bellomo, R., Ronco, C., Kellum, J. A., Mehta, R. L. &Palevsky, P. Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 8, R204 (2004).

2.      Bellomo, R., Kellum, J. A. &Ronco, C. Acute kidney injury. Lancet. 380, 756–766 (2012).

3.      Chertow, G. M., Burdick, E., Honour, M., Bonventre, J. V. & Bates, D. W. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 16, 3365–3370 (2005).

4.      De Mendonça, A. et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 26, 915–921 (2000).

5.      Uchino, S. et al. Acute renal failure in critically ill patients. J Am Med Assoc. 294, 813–818 (2005).

6.      Leung, K. C., Tonelli, M. & James, M. T. Chronic kidney disease following acute kidney injury—risk and outcomes. Nat Rev Nephrol. 9, 77–85 (2012).

7.      Susantitaphong, P. et al. World Incidence of AKI: A Meta-Analysis. Clin J Am Soc Nephrol. 8, 1482–1493 (2013).

8.      Liangos, O. et al. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 1, 43–51 (2006).

9.      Ricci, Z., Cruz, D. N. &Ronco, C. Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria. Nat Rev Nephrol. 7, 201–208 (2011).

10.  Ricci, Z. et al. Practice patterns in the management of acute renal failure in the critically ill patient: an international survey. Nephrol Dial Transpl. 21, 690–696 (2006).

11.  Mehta, R. et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit care. 11, R31 (2007)

12.  Lopes, Paulo Fernandes, Sofia Jorge, Sara Gonçalves, António Alvarez, Zélia Costa e Silva, Carlos França and Mateus Martins Prata Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications Critical Care 2008 12:R110

13.  Chang, Chih-Hsiang;  Acute Kidney Injury Classification: Comparison Of Akin And Rifle Criteria Shock: March 2010 -  33( 3):  247-252

14.  Sean M. Bagshaw. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients Nephrol Dial Transplant (2008) 23: 1569–1574

Corresponding Author

Dr Saurabh Sharma

KIMS & RC

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.