Abstract
The sensitivity and accuracy of the Risk/Injury/Failure/Loss/End-stage (RIFLE) versus acute kidney injury Network (AKIN) criteria for acute kidney injury (AKI) in critically ill patients remains uncertain. Therefore, we performed a systematic review and meta-analysis to investigate the incidence and prognostic value of the RIFLE versus AKIN criteria for AKI in critically ill patients. Literatures were identified by searching Medline, Embase, PubMed, and China National Knowledge Infrastructure (CNKI) database. Nineteen studies with 171,889 participants were included. The pooled estimates of relative risk (RR) were analyzed. We found that the RIFLE and AKIN criteria is different for the incidence of AKI in intensive care unit (ICU) patients (P = 0.02, RR = 0.88), while not for cardiac surgery patients (P = 0.30, RR = 0.93). For AKI-related hospital mortality, the AKIN criteria did not show a better ability in predicting hospital mortality in either ICU (P = 0.19, RR = 1.01) or cardiac surgery patients (P = 0.61, RR = 0.98) compared to RIFLE criteria. Our findings supported that the AKIN criteria can identify more patients in classifying AKI compared to RIFLE criteria, but not showing a better ability in predicting hospital mortality. Moreover, both RIFLE and AKIN criteria for AKI in cardiac surgery patients had better predictive ability compared with the ICU patients.
Highlights
Acute kidney injury (AKI) is the newly name replaced the term acute renal failure[1]
Acute kidney injury is very common with high hospital mortality in critically ill patients[31], epidemiological studies demonstrate the wide variation in etiologies and risk factors, developing into chronic kidney disease and progression to dialysis dependency[32,33]
A few modifications were added to acute kidney injury (AKI) including the eliminating the change of glomerular filtration rate (GFR) and the outcome categories of Loss and end-stage renal disease (ESRD); the stage 1 was redefined with an absolute increase in creatinine of at least 0.3 mg/dl; patients starting renal replacement therapy (RRT) are automatically classified as stage 3
Summary
Acute kidney injury (AKI) is the newly name replaced the term acute renal failure[1]. It is manifested with changes in urine output, creatinine and blood chemistries[2]. A consensus definition of AKI was published by the Acute Dialysis Quality Initiative (ADQI) in 20041. This consensus definition is termed the Risk/Injury/Failure/Loss/End-stage (RIFLE) criteria, and the following categories were used: ‘Risk’ is the least severe category of AKI, followed by ‘Injury’, ‘Failure’, ‘Loss’ and ‘End-stage renal disease’. We aimed to perform a systematic review and pool the available data to evaluate the incidence and prognostic value of the RIFLE and AKIN classification for AKI patients
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