The RIFLE criteria and mortality in acute kidney injury: A systematic review

In 2004, the Acute Dialysis Quality Initiative workgroup proposed a multilevel classification system for acute kidney injury (AKI) identified by the acronym RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Several studies have been published aiming to validate an...

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Bibliographic Details
Published in:Kidney international Vol. 73; no. 5; pp. 538 - 546
Main Authors: Ricci, Z., Cruz, D., Ronco, C.
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01.03.2008
Nature Publishing
Elsevier Limited
Subjects:
Acute Disease
acute renal failure definition
Biological and medical sciences
epidemiology
Female
Humans
Italy - epidemiology
Kidney Diseases - complications
Kidney Diseases - diagnosis
Kidney Diseases - mortality
Kidney Failure, Chronic - classification
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - mortality
Kidneys
Male
Medical sciences
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
outcome
Prognosis
Renal failure
RIFLE criteria
Severity of Illness Index
Urinary system involvement in other diseases. Miscellaneous
epidemiology
acute renal failure definition
RIFLE criteria
outcome
Kidney disease
Nephrology
Urinary system disease
Prognosis
Acute
Acute kidney injury
Mortality
Definition
Review
Epidemiology
Urology
Renal failure
Bibliographic review
ISSN:0085-2538, 1523-1755, 1523-1755
Online Access:Get full text
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Summary:In 2004, the Acute Dialysis Quality Initiative workgroup proposed a multilevel classification system for acute kidney injury (AKI) identified by the acronym RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Several studies have been published aiming to validate and apply it in clinical practice, verifying whether outcome progressively worsened with the severity of AKI. A literature search from August 2004 to June 2007 was conducted: 24 studies in which the RIFLE classification was used to define AKI were identified. In 13 studies, patient-level data on mortality were available for Risk, Injury, and Failure patients, as well as those without AKI (non-AKI). Death was reported at ICU discharge, hospital discharge, 28, 30, 60, and 90 days. The pooled estimate of relative risk (RR) for mortality for patients with R, I, or F levels compared with non-AKI patients were analyzed. Over 71 000 patients were included in the analysis of published reports. With respect to non-AKI, there appeared to be a stepwise increase in RR for death going from Risk (RR=2.40) to Injury (RR=4.15) to Failure (6.37, P<0.0001 for all). There was significant intertrial heterogeneity as expected with the varying patient populations studied. The RIFLE classification is a simple, readily available clinical tool to classify AKI in different populations. It seems to be a good outcome predictor, with a progressive increase in mortality with worsening RIFLE class. It also suggests that even mild degrees of kidney dysfunction may have a negative impact on outcome. Further refinement of RIFLE nomenclature and classification is ongoing.
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ISSN:0085-2538
1523-1755
1523-1755
DOI:10.1038/sj.ki.5002743