Abstract
Acute renal failure is common among hospitalized patients with HIV infection, particularly in the intensive care unit (ICU) setting, and increases mortality. Recently, the Acute Dialysis and Quality Initiative (ADQI) group [1] formulated a new classification for acute renal failure - the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification that defines three grades of severity - class R (risk), class F (failure), and class I (injury) - and two outcome classes - loss and end-stage kidney disease. Some studies [2,3] have applied the RIFLE criteria in hospitalized patients, particularly in ICU patients, but the clinical ability of these criteria to predict outcome of ICU HIV-infected patients has not yet been assessed. We sought to evaluate retrospectively the ability of the RIFLE criteria (Table 1) to predict outcome of the HIV-infected patients admitted to the Infectious Diseases ICU
Highlights
Serum creatinine × 1.5 Serum creatinine × 2 Serum creatinine × 3 or serum creatinine ≥4mg/dl with an acute rise >0.5 mg/dl Persistent acute renal failure = complete loss of kidney function >4 weeks End-stage kidney disease >3 months
12 patients (26%) were class R, 9 patients (19.5%) were class I, and 25 patients (54.3%) were class F; these patients did not differ in terms of age, gender, race, type of HIV, stage of HIV infection, highly active antiretroviral therapy (HAART), comorbidity, and severity of illness
Patients are categorized on serum creatinine or urinary output (UO), or both, and the criteria that led to the worst classification are used
Summary
Chronic kidney disease patients receiving dialysis were excluded from the analysis. We evaluated 97 HIV-infected patients (mean age 42.7 ± 12.2 years; 77 male, 69 Caucasian). According to RIFLE, 46 patients (47.4%; mean age 43.2 ± 11.08 years, P = not significant; 39 male, P = not significant; 28 Caucasian, P = not significant) had some degree of acute renal dysfunction.
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