Application of the RIFLE criteria in patients with crush-related acute kidney injury after mass disasters

Abstract

The term acute kidney injury (AKI) and its classification in strata defined as Risk, Injury, Failure, Loss and End-stage renal failure (RIFLE) need to be validated in different patient groups. RIFLE may be useful to foresee medical and logistic problems in crush-related AKI in disaster victims. Taken from the Marmara earthquake crush database, the subjects included 416 patients who were categorized according to the modified RIFLE criteria and 18 victims with crush injury but with normal serum creatinine who served as controls. Associations between each RIFLE category and various parameters were investigated. There were 27, 79 and 310 patients in the risk, injury and failure groups, respectively. Urine volume and serum albumin were lower; blood pressure, blood urea nitrogen, serum uric acid, potassium and phosphorus were higher; oliguric and polyuric periods were longer; medical complications were more frequent; and number of transfusions, dialysis sessions and days of dialysis support were higher in more severe AKI categories. Glomerular filtration rate at discharge was progressively lower in proportion to the severity of RIFLE classification. However, survival outcome did not differ among controls and patients who suffered from AKI nor in between RIFLE categories. In disaster crush victims, RIFLE classification can be useful to foresee the medical complications, need for therapeutic interventions and logistic support and also renal function at discharge though, perhaps, not survival.